A Case of Laparoscopic Left Hemicolectomy for Transverse Colon Cancer With Severe Obesity Performed Safely by Multidisciplinary Perioperative Management

A minimally invasive approach using laparoscopy or robotics has become the standard procedure in surgery for colorectal cancer. However, obesity is considered to be associated with a poor prognosis in laparoscopic colorectal surgery. Perioperative management, as well as the surgical procedure, is particularly important in severely obese patients. A case of colon cancer with severe obesity that underwent laparoscopic colectomy and was managed safely by multidisciplinary perioperative management in collaboration with a bariatric and metabolic surgery (BMS) team is presented. The patient was severely obese, with a body mass index (BMI) of 50.4 kg/m². After one month of preoperative weight loss intervention by the BMS team, the patient's weight was successfully decreased by approximately 15 kg (BMI: 46 kg/m²), and the patient underwent laparoscopic colectomy for transverse colon cancer in collaboration with the BMS team. In the laparoscopic surgery, a small incision for specimen removal was made above the umbilicus to insert the first trocar safely, and five additional trocars, whose placement was determined based on the target vessels of the dissected lymph nodes in reference to preoperative computed tomography (CT), were also inserted above the umbilicus. Gastrointestinal reconstruction was performed intracorporeally by an overlap technique using an endoscopic linear stapler to perform the procedure safely with minimal invasiveness. The patient was discharged on postoperative day eight without any postoperative complications, following early postoperative rehabilitation with intervention by the BMS team. The proportion of colorectal cancer patients with obesity is expected to increase in the future, and the establishment of multidisciplinary perioperative management and surgical techniques will be useful to improve the surgical outcomes and prognosis of colorectal cancer patients with severe obesity.