Preview

Kuban Scientific Medical Bulletin

Advanced search

SPLENIC FLEXURE MOBILIZATION DURING ANTERIOR RESECTION OF THE RECTUM FOR CANCER: SAFETY AND CANCER VALIDITY

Abstract

The regularity of the splenic flexure mobilization during operations for rectal cancer is called in question. To assess if the splenic flexure mobilization during rectum resection has an impact on early postoperative complications rate, mortality and the number of lymph nodes examined. Prospective comparative study. 940 patients underwent a selective surgery for colorectal adenocarcinoma T1-4N0-2M0-1 during 2003-2014. Patients were divided into two groups: with the splenic flexure mobilization (n = 359), and without splenic flexure mobilization (n = 581). The early postoperative complications rate did not have statistically significant difference. Postoperative mortality had statistically insignificant difference (1,1% vs. 2,9%, p = 0.06). The number of examined lymph nodes increases if the splenic flexure mobilization is performed (13±7,3 vs. 10,6 ± 6,6, p <0.001). The splenic flexure mobilization has no impact on the postoperative complications rate, anastomotic leakage rate and postoperative mortality. The number of examined lymph nodes is not sufficient in case of splenic flexure mobilization withholding and that may cause understaging.

About the Authors

V. V. Polovinkin
Колопроктологическое отделение ГБУЗ «Научно-исследовательский институт - Краевая клиническая больница № 1 имени профессора С. В. Очаповского» министерства здравоохранения Краснодарского края
Russian Federation


P. S. Pryn
Колопроктологическое отделение ГБУЗ «Научно-исследовательский институт - Краевая клиническая больница № 1 имени профессора С. В. Очаповского» министерства здравоохранения Краснодарского края
Russian Federation


V. V. Sapsay
ФГБОУ ВО КубГМУ Минздрава России
Russian Federation


References

1. Справочник по классификации злокачественных опухолей. Официальные рекомендации Американской объединенной комиссии по злокачественным новообразованиям / Перевод с английского. - СПб: Медакадемия, 2007. - 432 с.

2. Biondo S., Kreisler E., Fraccalvieri D. et al. Risk factors for surgical site infection after elective resection for rectal cancer. A multivariate analysis on 2131 patients // Colorectal dis. -2012. - Vol. 14. № 3. - P. 95-102.

3. Brennan D. J., Moynagh M., Brannigan A. E., et al. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer // Dis. colon. rectum. - 2007. -№ 3 (50). - P. 302-307.

4. Dixon A. R., Maxwell W. A., Holmes J. T. Carcinoma of the rectum: a 10-year experience // Br. j. surg. - 1991. - № 3 (78). -Р. 308-311.

5. Gouvas N., Gogos-Pappas G., Tsimogiannis K. et al. Impact of splenic flexure mobilization on short-term outcomes after laparoscopic left colectomy for colorectal cancer // Surg. laparosc. endosc. percutan. tech. - 2014. - № 5 (24). - P. 470-474.

6. Gravante G., Parker R., Elshaer M. et al. Lymph node retrieval for colorectal cancer: Estimation of the minimum resection length to achieve at least 12 lymph nodes for the pathological analysis // Int. j. surg. - 2016. - № 6 (25). - Р 153-157.

7. Hall N. R., Finan P. J., Stephenson B. M. et al. High tie of the inferior mesenteric artery in distal colorectal resections - a safe vascular procedure // Int. j. colorectal. dis. - 1995. -№ 1 (10). - P. 29-32.

8. Hallbook O., Johansson K., Sjodahl R. Laser Doppler blood flow measurement in rectal resection for carcinoma-comparison between the straight and colonic J pouch reconstruction // Br. j. surg. - 1996. - № 3 (83). - P. 389-392.

9. Hassan I., Pacheco P. E., Markwell S. J., Ahad S. Additional procedures performed during elective colon surgery and their adverse impact on postoperative outcomes // J. gastrointest. surg. - 2015. - № 3 (19). - Р 527-534.

10. Hiranyakas A., Da Silva G., Denoya P. et al. Colorectal anastomotic stricture: is it associated with inadequate colonic mobilization? // Tech. coloproctol. - 2013. - № 4 (17). -Р. 371-375.

11. International union against cancer (UICC). TNM classification of malignant tumours / Edited by Leslie H. Sobin and christian wittekind. - New York: Wiley-Liss, 2002. - 6th ed. -264 p.

12. Karanjia N. D., Corder A. P., Bearn P., Heald R. J. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum // Br. j. surg. - 1994. - № 8 (81). -Р. 1224-1226.

13. Katory M., Tang C. L., Koh W. L. et al. A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization // Colorectal. dis. - 2008. - № 2 (10). - P 165-169.

14. Kennedy R., Jenkins I. The case against mandatory mobilisation of the splenic flexure in left colonic and rectal malignancy // An. R col. surg. engl. - 2008. - № 8 (90). - Р. 638-640.

15. Konishi T., Watanabe T., Kishimoto J. et al. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance // An. surg. - 2006. - Vol. 244. № 5. - Р 758-763.

16. Kye B. H., Kim H. J., Kim H. S. et al. How much colonic redundancy could be obtained by splenic flexure mobilization in laparoscopic anterior or low anterior resection? // Int. j. med. sci. - 2014. - № 9 (11). - Р. 857-862.

17. Marsden M. R., Conti J. A., Zeidan S. et al. The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections // Colorectal. dis. - 2012. - № 10 (14). -P. 1255-1261.

18. Rullier E., Laurent C., Garrelon J. L. et al. Risk factors for anastomotic leakage after resection of rectal cancer // Br. j. surg. - 1998. - № 2 (85). - P. 355-358.

19. Stracci F., Bianconi F., Leite S. et al. Linking surgical specimen length and examined lymph nodes in colorectal cancer patients // Surgical oncology. - 2016. - № 2 (42). -P. 260-265.

20. Titu L. V., Tweedle E., Rooney P. S. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review // Dig. surg. - 2008. - № 2 (25). -Р. 148-157.

21. Yamamoto S., Fujita S., Akasu T. et al. Wound infection after elective laparoscopic surgery for colorectal carcinoma // Surg. endosc. - 2007. - Vol. 21. № 12. - P. 2248-2252.


Review

For citations:


Polovinkin V.V., Pryn P.S., Sapsay V.V. SPLENIC FLEXURE MOBILIZATION DURING ANTERIOR RESECTION OF THE RECTUM FOR CANCER: SAFETY AND CANCER VALIDITY. Kuban Scientific Medical Bulletin. 2016;(4):134-141. (In Russ.)

Views: 257


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1608-6228 (Print)
ISSN 2541-9544 (Online)