EP925 - Association of splenic flexure mobilization with perioperative complications in anterior and low anterior resections: A Retrospective Cohort Study

Tuesday, May 13, 2025

8:10 AM – 8:15 AM PT

ePoster Presenter(s)

Lily Park, MD MSc

Resident Physician
McMaster University
Hamilton, ON, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Tyler McKechnie, MD MSc (he/him/his)

Resident Physician
McMaster University
McMaster University
Hamilton, ON, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
OK

Olivia Kuszaj, n/a

Research Assistant
Division of General Surgery, Department of Surgery, McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.
Gaurav Talwar, Bsc, MD (he/him/his)

General Surgery PGY4
McMaster Univesity
Hamilton, Ontario, Canada

Disclosure information not submitted.
Sara Keshavjee, M.D. (she/her/hers)

Resident Physician
Division of General Surgery, McMaster University
McMaster University
Hamilton, Ontario, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
PS

Phil Staibano, MD

Resident Physician
McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.
NA

Nalin Amin, MD

Associate Professor, Surgery
Division of General Surgery, McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.
DH

Dennis Hong, MD, MSc

Associate Professor, Surgery
Division of General Surgry, McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.

Senior Author(s)

Cagla Eskicioglu, MD, MSc (she/her/hers)

Associate Professor, Surgery
Division of General Surgery, McMaster University
Hamilton, ON, Canada

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Lily Park, MD MSc: This individual has no financial relationships with ineligible companies.

Tyler McKechnie, MD MSc: This individual has no financial relationships with ineligible companies.

Sara Keshavjee, M.D.: This individual has no financial relationships with ineligible companies.

Cagla Eskicioglu, MD, MSc: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Anastomotic leaks are dreaded complications of colorectal surgery. To avoid this complication, several techniques can be considered to aid in the development of a tension-free, robust, and well-perfused anastomosis. Among these is splenic flexure mobilization (SFM) for left sided colon and rectal resections, where anastomotic tension is more pronounced. However, SFM can be technically challenging thereby increasing operative time and paradoxically may increase the risk of perioperative complications. Therefore, we conducted a population-level, retrospective cohort study to evaluate the impact of SFM on short-term postoperative outcomes following anterior resections (AR) and low anterior resections (LAR).

Methods/Interventions: Adult patients undergoing elective AR or LAR for colorectal neoplasia between 2016 and 2022 were identified in the American College of Surgeons (ACS) National Quality Improvement Program (NSQIP) database utilizing Current Procedure Terminology (CPT) codes and International Classification of Diseases, Tenth Revision (ICD-10) codes. The exposure of interest was intraoperative SFM. The primary outcome was 30-day major postoperative morbidity. The secondary outcomes included operative time, 30-day postoperative mortality, postoperative septic complications, 30-day readmission, re-operations, and postoperative length of stay (LOS). Multivariable regression models adjusted for various preoperative variables were fit for each outcome. Stratified analyses by AR and LAR were planned a priori.

Results/Outcomes: Overall, 88,925 patients were included. There were 31,105 (35.0%) patients that underwent SFM and 57,820 (65.0%) that did not. Most patients had undergone surgery for colon or rectal malignancy (95.5%) while the remaining patients had benign neoplasia (4.5%). Among those who underwent SFM, 30.0% were diverted compared to 25.9% of those without SFM. There were no differences between the SFM and no SFM groups for major morbidity (Odds ratio [OR] 1.02, 95% confidence interval [CI] 0.97-1.07). SFM was associated with increased operative time of 30 minutes (95% CI 27.7-30.9), 2.0% increased odds of postoperative septic complications (95% CI 1.0-1.2), and 8.2% increased odds of readmission to hospital within 30 days of the index operation (95% CI 1.03-1.14). There were no differences in mortality (OR 0.88, 95% CI 0.72-1.08), reoperations (OR 1.0, 95% CI 0.97-1.11), or postoperative LOS (0.04 days, 95% CI -0.2 to 0.1). Stratified analyses by AR and LAR demonstrated a similar pattern of findings.

Conclusion/Discussion: SFM in AR and LAR is not associated with increased major morbidity. However, those who undergo SFM are subject to increased operative time, and potentially increased odds of postoperative septic complications and increased odds of readmission to hospital within 30 days of the index operation. Although SFM remains an important consideration for tension-free anastomoses, careful consideration of appropriate indication by case may be preferred over routine SFM.