Totally laparoscopic resection of the splenic flexure for tumor

Colonic tumors located at the splenic flexure are rare and show a higher occlusive risk than other colorectal cancers. The totally laparoscopic segmental resection of splenic flexure represents a challenging procedure that requires adequate technical skills and for this reason it is still not widespread and validated. Between October 2010 and March 2012, a consecutive unselected series of eight (N = 8) patients underwent totally laparoscopic splenic flexure resection at our Institute. Data on patients' demographics, disease features, operative details and short-term follow-up were prospectively recorded in a specific database and retrospectively analyzed. All the operations were performed or supervised by the same surgeon (I. S.). We used a four-port medial-to-lateral standardized technique with intracorporeal anastomosis. A selective vascular ligation was performed in all cases and the specimens were extracted through a protected incision. Perioperative care plan and surgical instrumentations were standardized. Complications were classified using the Clavien-Dindo classification system. No conversion to open surgery was registered. All cases achieved an adequate number of lymph nodes harvested (22.9 +/- 5.2) and an oncologically correct resection of the tumor (proximal margin 7.0 +/- 2.4 cm, distal margin 7.1 +/- 2.8 cm). The mean hospital stay was 6.1 +/- 1.3 days. Postoperative complication rate according to the Clavien-Dindo system was 37.5 %, but all the complications reported were grade I. We did not observe any reoperation or readmission within 60 days after discharge. Totally laparoscopic splenic flexure resection is a feasible and reproducible technique. A correct surgical indication and a standardized technique allow to perform an oncologically safe and functionally effective treatment.