Splenic flexure mobilization at laparoscopic high anterior resection for cancer rectum; is it necessary?

Abstract

Background: it is acknowledged that laparoscopic colectomy for left sided colorectal cancer is the most common surgery operated in laparoscopic colorectal surgeries, However the most debatable question in such type of operations that is it mandatory to do splenic flexuremobilization (SFM) or not? In literatures, colorectal surgeons divided into 2 teams, those favouring SFM in laparoscopic left colorectal resection to have tension free, well vascularized anastomosis believing in that sigmoid colon is not suitable for anastomosis and the mobilization itself doesn't take significant operative time with considerable lower leakage rate Aim of Study: Compare between splenic flexure mobilization and nonsplenic flexure mobilization during laparoscopic‐assisted high anterior resection for patients with high rectal cancer regarding operative time, oncological safety and perioperative outcomes. Patients and Methods: Twenty‐seven patients with high rectal cancer were randomly assigned to SFM and non‐SFM groups. Study outcomes were the operative time, Intraoperative leakage detected by air‐leak test and postoperative leakage detected clinically and radiologically, Postoperative Ischemic colitis detected by endoscopy, oncological outcomes including tumor T stage, number of harvested lymph nodes, safety margins involvement, perineural invasion. Results: Twenty seven patients underwent laparoscopic high anterior resection for cancer rectum. Patients were grouped into Splenic flexure mobilization group (13 patients) and Non‐SFM group (14 patients). No significant difference was found between the 2 groups regarding mean blood loss or the outcome of intraoperative air leak test, the operative time was longer in SFM group (234.78 9 mins vs 196.13 7 mins in Non‐SFM group). No difference between the 2 groups for postoperative anastomotic leakage. Conclusion: Selective SFM could be done safely in laparoscopic high anterior resection for cancer rectum. Further studies that determine the adequate length of colonic conduit are required.