Syed Izna Najam, Hasan Mubeen, Badawi Mohammad, Liu Ben
General Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR.
General and Colorectal Surgery, Aston University, Birmingham, GBR.
Cureus. 2024 Nov 22;16(11):e74270. doi: 10.7759/cureus.74270. eCollection 2024 Nov.
Background Splenic flexure mobilization (SFM) is widely regarded as one of the most challenging steps in laparoscopic and robotic colorectal surgery, sparking ongoing debate. Some surgeons routinely advocate for SFM, citing its role in achieving greater left colonic reach, which facilitates a safe, tension-free, and well-vascularized anastomosis while adhering to oncological principles. Conversely, others argue that SFM does not consistently ensure these benefits and may increase the risk of complications, including splenic, bowel, or vascular injuries, as well as unnecessarily prolonging the procedure. While traditional surgical textbooks consider SFM a mandatory step in open colorectal resections, limited evidence supports its necessity in minimally invasive approaches. Aim This study aims to evaluate whether routinely mobilizing the splenic flexure offers advantages from both oncological and clinical perspectives. Materials and methods This retrospective cohort study evaluated the oncological and clinical outcomes of SFM versus splenic flexure preservation (SFP) in anterior resections for malignant pathologies. The study was conducted at New Cross Hospital in Wolverhampton, United Kingdom, over a 24-month period, from March 2022 to March 2024. Anterior resections for benign pathologies were excluded. Data analysis was performed using IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, NY, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Results This study included 94 patients, with 65 undergoing SFM and 29 having it preserved (SFP). No significant differences in baseline demographics (age and gender) were observed between the groups. Oncological outcomes revealed a significantly longer median length of resected specimens in the SFM group, although lymph node counts and high vascular ties were comparable between the groups. There were no differences in R0 resection rates. Clinical outcomes showed similar hospital stays and operation durations in both groups. The SFM group had a slightly higher rate of stoma formation but a lower incidence of anastomotic leaks compared to the SFP group. No significant differences in splenic injuries or other complications were noted. Conclusions Our study suggests that routine SFM offers certain oncological and clinical benefits. The specimens obtained were more complete for pathological staging. The additional length gained from the maneuver not only results in longer specimens but also provides sufficient mobility of the remaining colon, enabling anastomosis with minimal tension, which helps prevent anastomotic leaks. Surgeons may consider adjusting their practices based on the findings of this study.
背景 脾曲游离术（SFM）被广泛认为是腹腔镜和机器人结直肠手术中最具挑战性的步骤之一，引发了持续的争论。一些外科医生常规主张进行脾曲游离术，理由是其在实现左半结肠更大游离度方面的作用，这有助于在遵循肿瘤学原则的同时进行安全、无张力且血运良好的吻合。相反，另一些人则认为脾曲游离术并不能始终确保这些益处，可能会增加并发症的风险，包括脾脏、肠管或血管损伤，以及不必要地延长手术时间。虽然传统外科教科书认为脾曲游离术是开放性结直肠切除术的必要步骤，但有限的证据支持其在微创方法中的必要性。目的 本研究旨在评估常规游离脾曲从肿瘤学和临床角度是否具有优势。材料和方法 这项回顾性队列研究评估了在恶性病变的前切除术中行脾曲游离术（SFM）与保留脾曲（SFP）的肿瘤学和临床结果。该研究在英国伍尔弗汉普顿的新十字医院进行，为期24个月，从2022年3月至2024年3月。排除了良性病变的前切除术。使用IBM SPSS Statistics for Windows 24.0版（2016年发布；IBM公司，美国纽约州阿蒙克）和Microsoft Excel（微软公司，美国华盛顿州雷德蒙德）进行数据分析。结果 本研究纳入了94例患者，其中65例行脾曲游离术，29例保留脾曲（SFP）。两组之间在基线人口统计学特征（年龄和性别）方面未观察到显著差异。肿瘤学结果显示，脾曲游离术组切除标本的中位长度明显更长，尽管两组之间的淋巴结计数和高位血管结扎情况相当。R0切除率没有差异。临床结果显示两组的住院时间和手术时长相似。与保留脾曲组相比，脾曲游离术组造口形成率略高，但吻合口漏发生率较低。未观察到脾脏损伤或其他并发症的显著差异。结论 我们的研究表明，常规脾曲游离术具有一定的肿瘤学和临床益处。所获得的标本在病理分期方面更完整。该操作获得的额外长度不仅使标本更长，还为剩余结肠提供了足够的活动度，能够进行张力最小的吻合，这有助于预防吻合口漏。外科医生可根据本研究结果考虑调整他们的手术操作。
