[Mobilization of splenic flexure - routine or selective (results of a single-center randomized study)].

OBJECTIVE

To evaluate safety and effectiveness of routine splenic flexure mobilization (SFM) in surgical treatment of rectal cancer (RC).

MATERIAL AND METHODS

A single-center randomized study was performed between 2016 and 2019. Patients were randomized into 2 groups (SFM (+), =156, SFM(-), =67). Standard anterior and low anterior rectal resection was used. We used a combination of medial, lateral, and anterior approaches for SFM. Intraoperative, early and late postoperative complications, histological data, local recurrence, overall 3-year, relapse-free and cancer-specific survival were analyzed.

RESULTS

Surgery time was 253.2±72.8 and 252.0±78.0 min in the SFM(+) and SFM(-) groups, respectively (=0.98). Blood loss was 53.3±53.6 and 67.0±108.8 ml, respectively (=0.85), length of specimen - 28.6 (95% CI 27.2-29.9) and 24.0 cm (95% CI 22.2-25.7) (<0.0001). Length of residual fragment of sigmoid colon was 5.0 (95% CI 3.9-6.1) and 9.1 cm (95% CI 7.2-11.1) (<0.0001), respectively. The number of examined lymph nodes was 15.5 (95% CI 14.2-16.8) and 16.1 (95% CI 14.2-18.1) (=0.52), number of affected lymph nodes - 1.5 (95% CI 0.9-2.1) and 1.5 (95% CI 0.9-2.2), respectively (=0.38). Spleen damage was more common in the SFM (-) group (4.5% vs. 1.3%, =0.12). Logistic regression analysis indicates that SFM does not affect the incidence of spleen damage. Severity of postoperative complications was similar (=0.63). Anastomotic leak (AL) was more common in the SFM group (-) (17.9% vs. 9.6%, =0.04). AL grade B was more common in the SFM(-) group (=0.0001). Logistic regression analysis revealed the following predictors of anastomotic leakage: length of specimen and length of residual sigmoid colon. There was no significant relationship between SFM and incidence of local and systemic recurrences. Overall, cancer-specific and relapse-free 3-year survival was similar.

CONCLUSION

SFM is a safe procedure with various advantages. However, this approach does not improve intraoperative, early and long-term postoperative outcomes that does not allow us to recommend this approach for routine application.