Complete versus partial mobilization of splenic flexure during laparoscopic low anterior resection for rectal tumors: a comparative study.

BACKGROUND: The aim of the current study is to compare the results after partial and complete splenic flexure mobilization (SFM). SUBJECTS AND METHODS: The records of laparoscopic and hand-assisted laparoscopic procedures for primary rectal tumor patients were abstracted from a prospectively designed database. The phrenicocolic and splenocolic ligaments were divided via a four-trocar technique in the partial SFM group, and dissection was continued with the separation of gastrocolic and pancreaticomesocolic attachments via a five-trocar procedure in the complete SFM group. The following data were compared between the groups: Demographics, intra- and postoperative information, and pathological features.
RESULTS: In total, 122 cases (77 [63.1%] male, 58.2±13.2 years old) who underwent a partial (n=36, 29.5%) or a complete (n=86, 70.5%) SFM were included. Reservoir creation (48.8% versus 19.4%, P=.003) was more common and conversion (8.1% versus 22.2%, P=.039) was less frequent in the complete SFM group, but there were significantly more T4 tumors in the partial group (16.7% versus 2.3%, P=.008). Demographics, other intra- and postoperative parameters, and pathological features were identical.
CONCLUSIONS: In our study, complete SFM decreased conversion rates, but this finding may be related to the higher rate of T4 tumors in the partial SFM group. Complete SFM assures an increase in reservoir creation in patients receiving a low anterior resection. Because other parameters are identical, the decision for the level of SFM is better left to the surgeon in cases undergoing a low anterior resection, but complete SFM may be preferred in cases who are candidates for a reservoir formation.