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Routine splenic flexure mobilization may increase compliance with pathological quality metrics in patients undergoing low anterior resection
Author(s) -
Mouw T. J.,
King C.,
Ashcraft J. H.,
Valentino J. D.,
DiPasco P. J.,
AlKasspooles M.
Publication year - 2019
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14404
Subject(s) - medicine , splenic flexure , pathological , surgery , anastomosis , dissection (medical) , colorectal cancer , cancer , colonoscopy
Aim Mandatory splenic flexure mobilization ( SFM ) has been debated for rectal cancers. Proponents argue that additional mobilization facilitates a tension‐free anastomosis; however, this must be weighed against heightened morbidity. Little is known about the impact of specific techniques on pathology quality metrics. We aim to determine the impact of SFM on pathology quality metrics for patients undergoing rectal resections for colorectal adenocarcinoma. Method Patients were selected by querying the University of Kansas electronic medical records and the American College of Surgeons National Surgical Quality Improvement Program database based on Current Procedural Terminology codes. Patients were categorized as SFM or non‐ SFM . Primary outcomes were node yield less than 12 and margin length. Results There were 146 patients who met the inclusion criteria for chart review and 7369 included from the national database. Splenic flexure mobilization was associated with wider margins (3.52 vs 2.51 cm in low anterior resection, P < 0.01) and a decreased rate of inadequate nodal staging in patients undergoing low anterior resection (3.7% vs 19.3% P < 0.01). Conclusions SFM may affect surgical quality metrics in patients undergoing resection for distal colon and rectal adenocarcinoma. Further study is warranted to determine whether these differences in quality and pathology translate into differences in oncological outcomes.