Classification of the colonic splenic flexure based on three-dimensional CT analysis. Issue 1 (15th February 2021)

• Record Type: Journal Article
• Authors: Kawai, K; Nozawa, H; Hata, K; Tanaka, T; Nishikawa, T; Sasaki, K; Ishihara, S
• Is Part Of: BJS open. Volume 5:Issue 1(2021)
• Publication Date: 2021-02-15
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjsopen/zraa040
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection. Methods: CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization. Results: Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex ( P < 0.001), older age ( P = 0.004) and increased bodyweight ( P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006). Conclusion: Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure. Abstract : This study aimed to establish a classification to predict the difficulty of mobilizing the splenic flexure during colorectal surgery by analysing the three-dimensional coordinates of the splenic hilum and left renal hilum using cluster analysis. Three distinct groups were found: caudal, cranial and lateral locations.