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Splenic flexure mobilization in rectal cancer surgery: do we always need it?

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Abstract

Splenic flexure (SFM) in rectal cancer surgery is a crucial step which may increase the difficulty of the operation. The aim of this retrospective single-center study is to demonstrate if the selective omission of SFM during anterior rectal resection can reduce the complexity of the operation, without affecting post-operative and oncologic outcomes. Data of 112 consecutive rectal resections for cancer from March 2010 to March 2017 were analyzed and divided into two groups: SFM and No-SFM. A sub-analysis was then performed for laparoscopy and traditional cases. Post-operative and oncologic outcomes, including overall (OS) and cancer-related survival (CRS), were analyzed and compared. SFM was performed in 42% of cases and laparoscopy was used in 73.2%. Operative time resulted significantly lower in the No-SFM group (190 vs. 225 min, p = 0.01). In laparoscopy in the No-SFM group, operative time and post-operative stay were significantly lower (205.5 vs. 222.5 min, p = 0.04; 9 vs. 10 days, p = 0.01). Most of the open resections were performed without SFM (35.4% vs. 14.9%, p = 0.02). No statistical significant differences were found in OS and CRS in the two groups. We support the hypothesis that every surgeon should carry out an accurate intra-operative evaluation to perform a selective SFM. When possible, SFM can be safely avoided with no additional risks in terms of post-operative and oncologic outcomes.

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Authors and Affiliations

  1. Department of Surgery, Unit of General Surgery and Polytrauma, San Carlo Borromeo Hospital, Via Pio II n.3, 20153, Milan, Italy

    Francesco Ferrara, Daniele Gentile, Davide Gobatti & Marco Stella

  2. Department of Surgery, Unit of General Surgery III, San Carlo Borromeo Hospital, Milan, Italy

    Giuseppe Di Gioia & Giulia Carrara

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  1. Francesco Ferrara
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  2. Giuseppe Di Gioia
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  3. Daniele Gentile
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  4. Giulia Carrara
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  5. Davide Gobatti
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  6. Marco Stella
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Correspondence to Francesco Ferrara.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ferrara, F., Di Gioia, G., Gentile, D. et al. Splenic flexure mobilization in rectal cancer surgery: do we always need it?. Updates Surg 71, 505–513 (2019). https://doi.org/10.1007/s13304-018-0603-8

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  • DOI: https://doi.org/10.1007/s13304-018-0603-8

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