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01-09-2019 | Original Article

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

Authors: Francesco Ferrara, Giuseppe Di Gioia, Daniele Gentile, Giulia Carrara, Davide Gobatti, Marco Stella

Published in: Updates in Surgery | Issue 3/2019

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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Title: Splenic flexure mobilization in rectal cancer surgery: do we always need it?
Authors: Francesco Ferrara
Giuseppe Di Gioia
Daniele Gentile
Giulia Carrara
Davide Gobatti
Marco Stella
Publication date: 01-09-2019
Publisher: Springer International Publishing
Published in: Updates in Surgery / Issue 3/2019
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-018-0603-8

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

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