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

  • Published:
Diseases of the Colon & Rectum

Purpose

Splenic flexure mobilization is widely considered to be an essential component of anterior resection for rectal cancer. It was our hypothesis that selective splenic flexure mobilization would reduce operative times without increasing morbidity or affecting cure.

Methods

A total of 100 consecutive patients with rectal cancer (mean 8 (range, 4–15) cm from anal verge) who underwent anterior resection for cure between 1996 and 2002 had splenic flexure mobilization only as required to achieve a tension-free anastomosis. Operative time, postoperative morbidity, pathologic findings, and recurrence rates were recorded.

Results

There were no clinicopathologic differences between those who had splenic flexure mobilization (n = 26) and those who did not (n = 74). Mean operative time in the splenic flexure mobilization group was longer, 167 (range, 130–200) minutes vs. 120 (range, 95–180) minutes in the nonmobilized group (P = 0.023). Mean length of specimen resected was longer in the splenic flexure mobilization group: 36 vs. 18 cm (P = 0.008). Anastomotic complications (4 percent), local recurrence (7 percent, median follow-up, 38 months), perioperative morbidity (32 percent) and mortality (2 percent), and survival did not differ between the two groups.

Conclusions

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.

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References

To the Article

  1. W Miles (1908) ArticleTitleA method for performing abdomino-perineal excision for carcinoma of the rectum and terminal portion of the pelvic colon Lancet ii 1812–1813

    Google Scholar 

  2. B Eisenberg JJ Decosse F Harford J Michalek (1982) ArticleTitleCarcinoma of the colon and rectum: the natural history reviewed in 1704 patients Cancer 49 1131–1134 Occurrence Handle7059938 Occurrence Handle10.1002/1097-0142(19820315)49:6<1131::AID-CNCR2820490611>3.0.CO;2-T Occurrence Handle1:STN:280:Bi2C3snmt1Y%3D

    Article  PubMed  CAS  Google Scholar 

  3. TD Cecil R Sexton BJ Moran RJ Heald (2004) ArticleTitleTotal mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer Dis Colon Rectum 47 1145–1150 Occurrence Handle15164243 Occurrence Handle10.1007/s10350-004-0086-6

    Article  PubMed  Google Scholar 

  4. RJ Heald BJ Moran RD Ryall R Sexton JK MacFarlane (1998) ArticleTitleRectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997 Arch Surg 133 894–899 Occurrence Handle9711965 Occurrence Handle10.1001/archsurg.133.8.894 Occurrence Handle1:STN:280:DyaK1cznsFOrsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. HG Moore JG Guillem (2003) ArticleTitleMultimodality management of locally advanced rectal cancer Am Surg 69 612–619 Occurrence Handle12889627

    PubMed  Google Scholar 

  6. E Kapiteijn CA Marijnen ID Nagtegaal et al. (2001) ArticleTitlePreoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–646 Occurrence Handle11547717 Occurrence Handle10.1056/NEJMoa010580 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. RT Poon KW Chu JW Ho CW Chan WL Law J Wong (1999) ArticleTitleProspective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision World J Surg 23 463–467 Occurrence Handle10085394 Occurrence Handle10.1007/PL00012331 Occurrence Handle1:STN:280:DyaK1M7oslenug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. EL Rullier C Laurent JL Garrelon P Michel J Saric M Parneix (1998) ArticleTitleRisk factors for anastomotic leakage after resection of rectal cancer Br J Surg 85 355–358 Occurrence Handle9529492 Occurrence Handle10.1046/j.1365-2168.1998.00615.x Occurrence Handle1:STN:280:DyaK1c7ptVaruw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. P Surtees JK Ritchie RK Phillips (1990) ArticleTitleHigh versus low ligation of the inferior mesenteric artery in rectal cancer Br J Surg 77 618–621 Occurrence Handle2383724 Occurrence Handle10.1002/bjs.1800770607 Occurrence Handle1:STN:280:By%2BA2crhtlc%3D

    Article  PubMed  CAS  Google Scholar 

  10. O Hallbook K Johansson R Sjodahl (1996) ArticleTitleLaser Doppler blood flow measurement in rectal resection for carcinoma-comparison between the straight and colonic J pouch reconstruction Br J Surg 83 389–392 Occurrence Handle8665202 Occurrence Handle10.1002/bjs.1800830330 Occurrence Handle1:STN:280:BymB2cnislU%3D

    Article  PubMed  CAS  Google Scholar 

  11. DR Prytherch MS Whiteley B Higgins PC Weaver WG Prout SJ Powell (1998) ArticleTitlePOSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity Br J Surg 85 1217–1220 Occurrence Handle9752863 Occurrence Handle10.1046/j.1365-2168.1998.00840.x Occurrence Handle1:STN:280:DyaK1cvitlOrtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. D Ignjatovic B Djuric V Zivanovic (2001) ArticleTitleIs splenic lobe/segment dearterialization feasible for inferior pole trauma during left hemicolectomy? Tech Coloproctol 5 23–25 Occurrence Handle11793256 Occurrence Handle10.1007/s101510100004 Occurrence Handle1:STN:280:DC%2BD38%2FmsF2lsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. KC Peeters RA Tollenaar CA Marijnen et al. (2005) ArticleTitleRisk factors for anastomotic failure after total mesorectal excision of rectal cancer Br J Surg 92 211–216 Occurrence Handle15584062 Occurrence Handle10.1002/bjs.4806 Occurrence Handle1:STN:280:DC%2BD2M7hslyjsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. FK Welsh M McFall G Mitchell WF Miles WG Woods (2003) ArticleTitlePre-operative short-course radiotherapy is associated with faecal incontinence after anterior resection Colorectal Dis 5 563–568 Occurrence Handle14617241 Occurrence Handle10.1046/j.1463-1318.2003.00480.x Occurrence Handle1:STN:280:DC%2BD3srjslWnsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

To the Editorial Comment

  1. JF Rafferty (2001) ArticleTitleObtaining adequate bowel length for colorectal anastomosis Clin Colon Rectal Surg 14 25–31 Occurrence Handle10.1055/s-2001-13140

    Article  Google Scholar 

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Authors and Affiliations

  1. UCD School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland

    D. J. Brennan M.B., M. Rowland Ph.D. & P. Ronan O’Connell M.D.

  2. UCD School of Medicine and Medical Science, University College Dublin, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland

    D. J. Brennan M.B., M. Moynagh M.B., A. E. Brannigan M.Ch., F. Gleeson M.D. & P. Ronan O’Connell M.D.

Authors
  1. D. J. Brennan M.B.
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  2. M. Moynagh M.B.
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  3. A. E. Brannigan M.Ch.
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  4. F. Gleeson M.D.
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  5. M. Rowland Ph.D.
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  6. P. Ronan O’Connell M.D.
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Correspondence to P. Ronan O’Connell M.D..

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Brennan, D.J., Moynagh, M., Brannigan, A.E. et al. Routine Mobilization of the Splenic Flexure is not Necessary During Anterior Resection for Rectal Cancer. Dis Colon Rectum 50, 302–307 (2007). https://doi.org/10.1007/10350-006-0811-z

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  • DOI: https://doi.org/10.1007/10350-006-0811-z

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