Laparoscopic Versus Open Resection Without Splenic Flexure Mobilization for the Treatment of Rectum and Sigmoid Cancer

A Study From a Single Institution That Selectively Used Splenic Flexure Mobilization

Abstract

Introduction 

We have hypothesized that splenic flexure mobilization might be selectively undertaken in laparoscopic surgery (LAP) for rectal or sigmoid colon cancer.

Patients and Methods 

Oncologic clearance and postoperative morbidity were compared between 119 LAP patients and 145 open surgery (OS), all of whom were treated without splenic flexure mobilization.

Results 

The operative time was similar in the 2 groups (P>0.05). The complication rate was lower after LAP than after OS (10.0% vs. 25.5%, P=0.043). Anastomotic leakage occurred in 1 patient after LAP. On a median 29-month follow-up, the local recurrence rates did not differ significantly between the 2 groups (0.9% for LAP vs. 2.6% for OS).

Conclusions 

Laparoscopic procedures without routine splenic flexure mobilization do not increase postoperative morbidity or oncologic risk, as compared with OS. We suggest that laparoscopic rectal and sigmoid cancer resection can be safely conducted with selective splenic flexure mobilization.