Recently, the team led by Professor Sun Xuejun from Department of General Surgery of the First Affiliated Hospital of Xi’an Jiaotong University (XJTU) successfully performed the first case of laparoscopic radical resection of descending colon cancer in a patient with situs inversus totalis in northwest China, which is also the second successful surgery in a patient with situs inversus totalis performed by Department of General Surgery.

According to literature review, 13 cases of situs inversus totalis complicated with colon cancer have been reported abroad and four cases in China. The variation of anatomical structures will disrupt the anatomy knowledge of the surgeons and bring significant obstacles to the surgery.

The patient was admitted to Department of General Surgery of our hospital due to the chief complaint of "upper right abdominal pain for over half a month and aggravated for 4 d". CT scan of chest and abdomen after admission showed that the positions of all thoracic and abdominal organs were opposite. The patient was diagnosed with the descending colon cancer complicated with situs inversus totalis after explicit and comprehensive preoperative examinations. Multidisciplinary consultation was conducted to determine comprehensive diagnosis and treatment regimes. The imaging data were considered, preoperative consultation was delivered, anatomical structure of situs inversus totalis was repeatedly constructed and reverse surgical procedures were prepared and simulated. A surgical team consisting of Director Sun Xuejun, Associate Professor Zhao Wei, Associate Professor Zheng Jianbao and Resident Physician Yu Junhui successfully performed laparoscopic radical resection of the descending colon cancer for this patient on November 9, 2020. Intraoperatively, the team accurately identified the adjacent structures of organs, confirmed the anatomical relationship, delivered complete and standardized descending colon resection and regional lymph node dissection and successfully accomplished the surgery. The patient was properly recovered and discharged from hospital. This is the first case of laparoscopic radical resection of descending colon cancer in a situs inversus totalis patient in Northwest China, which is extremely rare in clinical practice.