Routine Mobilization of the Splenic Flexure is not Necessary During Anterior Resection for Rectal Cancer

Abstract

Routine splenic flexure mobilization is not required for safe anterior resection in patients with rectal cancer. Avoiding splenic flexure mobilization results in shorter operative times and does not increase postoperative morbidity, anastomotic leakage, or local recurrence.

Technical difficulties of left colic artery preservation during left colectomy for colon cancer

“…The LT technique might have some advantages in terms of vascularization of the colon limb in particular cases of double localizations (left and right) or in patients with atherosclerosis. However, during an HT procedure, the high IMV ligation has been reported to increase mesenteric venous blood pressure [4]. In cases of a double IMV section, venous ligations are equivalent to the ligation of the left colic vein and could, therefore, be responsible for a higher venous stasis than during an HT procedure.…”

Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer

“…The reasons for using splenic flexure mobilization for sigmoid colon cancer were that the tumor was located near the sigmoid-descending junction in ten cases, proximal multiple diverticular disease in two cases, and for tension-free anastomosis in one case. The necessity of splenic flexure mobilization for sigmoid colon cancer may differ between Western and Asian countries, which may be associated with length of sigmoid colon and relative quantity of mesenteric fat [17,19,20]. Furthermore, splenic flexure mobilization could be omitted in patients with long sigmoid colon by preserving the superior rectal artery to save blood supply to the distal sigmoid colon.…”

Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study

“…Therefore, different degrees of colon detachment may result form different techniques of SF mobilization. As result, selective SF mobilization is currently adopted by many surgeons worldwide (4) . We sought to measure the effect of two different techniques for SF mobilization on colon lengthening for colorectal anastomosis using an open surgery cadaver model.…”

“…In these cases, by preserving the superior rectal artery, the blood supply to the distal colon remains intact. Hence, some authors have hypothesized that SF mobilization might be selectively undertaken for rectal cancer surgery (4,11) . Thus, since there is currently no consensus regarding the role of routine SF mobilization for rectal resection, our results providing an estimate about the extent of mobilized left colon derived from partial or full SF mobilization may contribute to solve some controversy.…”

“…Several maneuvers may be used to allow progressive release of the left colon to provide a tension-free anastomosis to the low rectum (13) . One such maneuver, splenic flexure (SF) mobilization, is considered to be an important technical component of anterior rectal resection and low colorectal anastomosis (4) .…”