Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Abstract

Purpose: Splenic flexure mobilization (SFM) is a challenging step during laparoscopic colorectal operations. This study aims to inspect the predicting measures and consequences of lengthened SFM duration during laparoscopic distal colorectal cancer surgery. Methods: Patients underwent elective laparoscopic anterior or low anterior resection (AR or LAR) for distal sigmoid or rectal cancer were included. Data were abstracted from a prospectively designed database. A blinded observer to the patients and procedures watched the operation videos and tiered the steps of the procedures into 5 as follows: 1) medial-to-lateral dissection, 2) pelvic dissection, 3) dissection of the white line, 4) SFM, and 5) stapling, resection, extraction of the specimen and anastomosis. Patient and disease related measures predicting SFM duration and consequences of lengthened SFM duration were investigated. Results: A total of 105 patients (62 male, 59%) treated with AR (n=41) or LAR (N=64) were included to the study. No other patient or disease related features, but patients’ body mass index (BMI), weight and height were found to be significant predicting measures for lengthened SFM duration (p=0.0086, p=0.002 and p=0.43, respectively). The duration of SFM was correlating with the intervals of steps 1 (p=0.0013), 3 (p=0.0088) and 5 (p=0.04) and total operation time (p<0.0001). Lengthened SFM did not worsen postoperative measures including complications, hospitalization period and early oncological outcomes. Conclusions: Patients’ BMI, weight and height are the predicting measures for SFM duration at the time of laparoscopic distal colectomies. SFM duration shows a strong correlation with the durations of almost all other steps and total operation time but does not affect perioperative measures. Trial registration: E-10840098-772.02-61604 2.2.2019