Effect of splenic flexure mobilization performed via medial-to-lateral and superior-to-inferior approach on early clinical outcomes in elective laparoscopic resection of rectal cancer.

Abstract

IntroductionWhether complete splenic flexure mobilization (SFM) is required remains a controversial issue and there are numerous approaches regarding the performance of this procedure.AimTo investigate the effect of SFM performed with a medial-to-lateral and superior-to-inferior approach on early clinical outcomes in laparoscopic resection of rectal cancer.Material and methodsThe SFM procedure was initiated by the ligation of the inferior mesenteric vein followed by dissection extending from the upper border of the pancreas to the splenic hilum through the gastrocolic space. The mesocolon was dissected in a superior-to-inferior and medial-to-lateral fashion and the presacral space was entered by dividing the inferior mesenteric artery. The procedure was completed by dividing all the splenocolic, phrenicocolic, gastrocolic, and pancreaticomesocolic ligaments.ResultsA total of 43 patients were included in the study, comprising 26 (60.5%) men and 17 (39.5%) women with a mean age of 58.2 ±13.9 (range: 30–87) years. Of the 43 patients, 21 (48.8%) underwent neoadjuvant chemotherapy and a diversion stoma was performed in 37 (86%) patients. No adjacent organ injury occurred intraoperatively. Mean operative time was 271 ±50 min and mean blood loss was 144 ±83 ml. One (2.3%) patient might have developed anastomotic leakage secondary to bevacizumab therapy postoperatively and developed no anastomotic stenosis in the follow-up period. Mean length of hospital stay was 9.3 ±4.3 days and no mortality occurred in any patient.ConclusionsSplenic flexure mobilization performed via the superior-to-inferior and medial-to-lateral approach appears to be a safe and feasible procedure.

The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study.

“…Therefore, LLND is an important procedure for locally advanced lower rectal cancer with clinically suspected swollen lymph nodes. Laparoscopy is a popular technique in colorectal surgery around the world due to its remarkable advantages [ 11 ]. However, it is well known that laparoscopic LLND in cases of advanced middle and low rectal cancer with enlarged lateral lymph nodes is a complex and challenging surgery.…”

Effect of preoperative chemoradiotherapy on perioperative outcomes in patients undergoing laparoscopic rectal cancer surgery

“…TME was administered using the standard procedure. [16,17] A standard pathologic examination was performed for all the resected specimens. Each specimen was evaluated for tumor differentiation, depth of tumor penetration, and lymph node metastases.…”

Cadaveric Study of Colon Lengthening Maneuvers Following Sigmoidectomy

“…4,10 Previous studies have attempted to quantify length obtained with various colonic mobilization procedures in isolation, but few have attempted to understand their effect in combination. 5,11,12 In this study, we quantified the average lengths gained with left colon–lengthening maneuvers with hopes to inform operative decision-making when fashioning a tension-free, well-vascularized intestinal anastomosis after sigmoidectomy and complete proctectomy.…”