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.