We present an extended paraortic laparoscopic lymphadenectomy performed in a 28 years old male diagnosed with advanced left colon adenocarcinoma (9/11) extended to the renal fatty tissue and abdominal wall. The preoperative CT scan revealed a large periaortic mass consisting in multiple enlarged tumoral lymph nodes extremely adherent to the aortic wall. . The hemorrhage was managed laparoscopically with clips and the total amount of blood lost was 450 ml. The extended left hemicolectomy was performed laparoscopically and the postoperative outcome was uneventful. The patient was discharged in the 6-th postoperative day. The histological exam revealed 44 lymph nodes of whom 17 were positive.
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