a 59 yrs old man with T3N0 adenocarcinoma of rectal cancer at 10 cm above anal verge and a malignant tumor ( adenocarcinoma) at ascending colon simultanously ,no metastasis in CT scan,
Personally I will choose a low anterior resection with total mesolectal excision and colorectal anastomosis (after short course neoadjuvant radiochemotherapy), right hemicolectomy with total mesocolic excision and central vascular ligation (ligating the middle colic at is origin) and ileotransversoanastomosis and a loop ileostomy before the two anastomosis.
Low ant resection and right hemicolectomy with covering ileostomy followed by chemotherapy
Was the Location of the rectal Tumor confirmed on rigid rectoscopy? (the Location on colonoscopy does not always corresponds with the finding on rigid rectoscopy)
If yes, I would go with Ionut.
One critical aspect in this case however is the vascular architecture. I wouldn´t do a high tie (central ligation ) of the middle colic artery as suggested by Ionut. The middle Colic artery might represent the key vessel in the postoperative Situation. A low tie (ligating the right branch of the middle colic artery) provides the same oncologic result. You wanna have a good vascularization of your anastomoses !!
I think the approach suggested by Dr. Peter is right. If you go too close to the origin of the middle colic the vascularity of the remnant will be an issue. Tackling only the right branch of Middle colic is enough. For the low anterior resection too, see how best the arcade of Riolan and Drummond gets preserved, else the anastomoses will be in a jeopardy. If in doubt, you can go ahead with a total colectomy which though worsens the patient's quality of life.
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