A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization

• Published in: Colorectal disease Vol. 10; no. 2; pp. 165 - 169
• Main Authors: Katory, M., Tang, C. L., Koh, W. L., Fook-Chong, S. M. C., Loi, T. T., Ooi, B. S., Ho, K. S., Eu, K. W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2008
• Subjects: Adult; Aged; Aged, 80 and over; Anterior resection; Chi-Square Distribution; Colectomy - methods; Colon, Transverse - surgery; Colorectal Neoplasms - surgery; Female; Humans; Male; Middle Aged; morbidity and mortality; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; splenic flexure; Statistics, Nonparametric; surgical technique; Treatment Outcome
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2007.01265.x

Objective  High anterior resection (HAR) for colorectal cancer is traditionally performed with routine mobilization of the splenic flexure. This is a retrospective review of mortality and morbidity following HAR in which the splenic flexure has been preserved. Method  From a prospective database, all patients who had undergone elective HAR for colorectal cancer between 1999 and 2005 were identified. Morbidity, mortality, pathology and survival data for patients having HAR with and without splenic flexure mobilization were analysed. Results  A total of 707 patients were identified. Five hundred and thirty‐one had HAR with preservation of the splenic flexure. In these patients outcome was: anastomotic leak (0.4%), wound infection (3.6%), anastomotic stricture (0.4%) and 30‐day mortality (0.9%). No statistical significant difference was found for postoperative morbidity (P = 0.1926), 30‐day mortality (P =0.3285), lymph node harvest (P = 0.2127) or survival (P = 0.1457) compared with patients in whom the splenic flexure was mobilized. Longitudinal resection margins were greater following HAR with splenic flexure mobilization (P < 0.0001). Conclusion  No morbidity, oncological or survival disadvantage in performing splenic flexure preserving HAR was found.