title: Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer.
abstract: OBJECTIVE
  Splenic flexure mobilization is widely considered to be an essential component of anterior resection for rectal cancer. It was our hypothesis that selective splenic flexure mobilization would reduce operative times without increasing morbidity or affecting cure.
  
  
  METHODS
  A total of 100 consecutive patients with rectal cancer (mean 8 (range, 4-15) cm from anal verge) who underwent anterior resection for cure between 1996 and 2002 had splenic flexure mobilization only as required to achieve a tension-free anastomosis. Operative time, postoperative morbidity, pathologic findings, and recurrence rates were recorded.
  
  
  RESULTS
  There were no clinicopathologic differences between those who had splenic flexure mobilization (n = 26) and those who did not (n = 74). Mean operative time in the splenic flexure mobilization group was longer, 167 (range, 130-200) minutes vs. 120 (range, 95-180) minutes in the nonmobilized group (P = 0.023). Mean length of specimen resected was longer in the splenic flexure mobilization group: 36 vs. 18 cm (P = 0.008). Anastomotic complications (4 percent), local recurrence (7 percent, median follow-up, 38 months), perioperative morbidity (32 percent) and mortality (2 percent), and survival did not differ between the two groups.
  
  
  CONCLUSIONS
  Routine splenic flexure mobilization is not required for safe anterior resection in patients with rectal cancer. Avoiding splenic flexure mobilization results in shorter operative times and does not increase postoperative morbidity, anastomotic leakage, or local recurrence.
authors.affiliation: UCD School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Brennan
authors.forename: M
authors.initials: M
authors.lastname: Moynagh
authors.forename: A E
authors.initials: AE
authors.lastname: Brannigan
authors.forename: F
authors.initials: F
authors.lastname: Gleeson
authors.forename: M
authors.initials: M
authors.lastname: Rowland
authors.forename: P Ronan
authors.initials: PR
authors.lastname: O'Connell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D044684:Colon, Transverse / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome