ABSTRACT
The left colon is unique as it receives its blood supply from both the superior and inferior mesenteric arterial systems, with some arterial anastomotic communication between the two systems usually present around the splenic flexure. The left colic artery serves as the dominant arterial supply, and the preferred pathway for lymphatic drainage for splenic flexure lesions in the majority of patients. Complete mesocolic excision involves dissection of the colon within an intact mesocolic plane, ligation of the feeding vessels at their origin, and resection of at least 10 cm of bowel on either side of the lesion. This technique has a sound oncological basis and has been shown to result in a better disease-free survival rate. Extended right hemicolectomy, left hemicolectomy, and left segmental colectomy are oncologically equivalent resection templates for malignant splenic flexure lesions. Unique clinical presentations warrant a tailor-made surgical approach. Laparoscopy for radical left colectomy for cancer is an accepted standard of care. This chapter deals with the surgical anatomy of the left colon, the surgical approaches to left colon cancer, and the technical details of laparoscopic left hemicolectomy.
