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Splenic flexure mobilization and anastomotic leakage in anterior resection for rectal cancer: a multicentre cohort study
Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0002-0974-6373
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0002-8601-0159
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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2023 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 112, no 4, p. 246-255Article in journal (Refereed) Published
Abstract [en]

Background and objective: Some colorectal surgeons advocate routine splenic flexure mobilization (SFM) when performing anterior resection for rectal cancer to ensure a tension-free anastomosis. Meta-analyses of smaller studies suggest that this approach does not influence anastomotic leakage rates, but larger multicentre studies are needed to confirm the safety of a selective strategy. The aim of this study is to evaluate the impact of SFM on anastomotic leakage.

Methods: This is a retrospective multicentre cohort study, comprising 1109 patients operated with anterior resection for rectal cancer in 2014–2018. Exposure was SFM, while anastomotic leakage within a year constituted the outcome. Stratified analyses were performed for type of mesorectal excision and surgical approach, as well as sensitivity analysis considering vascular tie placement. Multivariable Cox regression with hazard ratios (HRs) and 95% confidence intervals (CIs) was employed to adjust for confounding, while multiple imputation was used for missing data.

Results: SFM was performed in 381 patients (34.4%). Anastomotic leakage occurred in 83 (21.8%) and 123 (20.3%) patients operated with and without SFM, respectively. SFM was neither clearly detrimental nor beneficial regarding anastomotic leakage (adjusted HR = 0.82; 95% CI: 0.59–1.15), with no apparent differences for total or partial mesorectal excision and minimally invasive or open surgery. Concurrent high vascular ligation did not impact these results, and there was no evidence of interaction from centers with a more common use of SFM.

Conclusions: SFM did not seem to influence the risk of anastomotic leakage after anterior resection for rectal cancer, regardless of type of mesorectal excision, use of minimally invasive surgery, or high vascular ligation.

Place, publisher, year, edition, pages
Sage Publications, 2023. Vol. 112, no 4, p. 246-255
Keywords [en]
adenocarcinoma, dehiscence, Insufficiency, leak, rectum, splenic flexure
National Category
Surgery Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-214537DOI: 10.1177/14574969231181222ISI: 001060070200001PubMedID: 37675547Scopus ID: 2-s2.0-85170522374OAI: oai:DiVA.org:umu-214537DiVA, id: diva2:1800302
Funder
Knut and Alice Wallenberg Foundation, RV-762241Swedish Society of Medicine, SLS-934594Cancerforskningsfonden i Norrland, AMP 19-978Bengt Ihres Foundation, SLS-934603Swedish Cancer Society, CAN 2018/589Available from: 2023-09-26 Created: 2023-09-26 Last updated: 2024-02-01Bibliographically approved

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Rutegård, MartinSvensson, Johan

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Wallenberg Centre for Molecular Medicine at Umeå University (WCMM)Department of Surgical and Perioperative SciencesStatistics
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