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Abstract：
Splenic flexure mobilization (SFM) may be indicated during anterior resection to provide a tension-free anastomosis. However, to date, no score allows identifying patients who may benefit from SFM.
Patients who underwent robotic anterior resection for rectal cancer were identified from a prospective register. Demographic and cancer-related variables were extracted, and predictors of SFM were identified using regression models. Thereafter, 20 patients with SFM and 20 patients without SFM were randomly selected and their pre-operative CTscan were reviewed. The radiological index was defined as 1/(sigmoid length/pelvis depth). The optimal cut-off value for predicting SFM was identified using ROC curve analysis.
Five hundred and twenty-four patients were included. SFM was performed in 121 patients (27.8%) and increased operative time by 21.8 min (95% CI: 11.3 to 32.4, p < 0.001). The incidence of postoperative complications did not differ between patient with or without SFM. Realization of an anastomosis was the main predictor for SFM (OR: 42.4, 95% CI: 5.8 to 308.5, p < 0.001). In patients with colorectal anastomosis, both sigmoid length (15 ± 5.1 cm versus 24.2 ± 80.9 cm, p < 0.001) and radiological index (1 ± 0.3 versus 0.6 ± 0.2, p < 0.001) differed between patients who had SFM and patients who did not. ROC curve analysis of the radiological index indicated an optimal cut-off value of 0.8 (sensitivity: 75%, specificity: 90%).
SFM was performed in 27.8% of patients who underwent robotic anterior resection, and increased operative time by 21.8 min. For optimal surgical planning, patients requiring SFM can be identified based on pre-operative CT using the index 1/(sigmoid length/pelvis depth) with a cut-off value set at 0.8.
Patients who underwent robotic anterior resection for rectal cancer were identified from a prospective register. Demographic and cancer-related variables were extracted, and predictors of SFM were identified using regression models. Thereafter, 20 patients with SFM and 20 patients without SFM were randomly selected and their pre-operative CTscan were reviewed. The radiological index was defined as 1/(sigmoid length/pelvis depth). The optimal cut-off value for predicting SFM was identified using ROC curve analysis.
Five hundred and twenty-four patients were included. SFM was performed in 121 patients (27.8%) and increased operative time by 21.8 min (95% CI: 11.3 to 32.4, p < 0.001). The incidence of postoperative complications did not differ between patient with or without SFM. Realization of an anastomosis was the main predictor for SFM (OR: 42.4, 95% CI: 5.8 to 308.5, p < 0.001). In patients with colorectal anastomosis, both sigmoid length (15 ± 5.1 cm versus 24.2 ± 80.9 cm, p < 0.001) and radiological index (1 ± 0.3 versus 0.6 ± 0.2, p < 0.001) differed between patients who had SFM and patients who did not. ROC curve analysis of the radiological index indicated an optimal cut-off value of 0.8 (sensitivity: 75%, specificity: 90%).
SFM was performed in 27.8% of patients who underwent robotic anterior resection, and increased operative time by 21.8 min. For optimal surgical planning, patients requiring SFM can be identified based on pre-operative CT using the index 1/(sigmoid length/pelvis depth) with a cut-off value set at 0.8.
摘要：
背景：在前切除术期间可能需要进行脾曲动员（SFM），以提供无张力吻合。然而,到目前为止,没有评分可以确定可能受益于SFM的患者.
方法：从前瞻性登记中确定接受机器人直肠癌前切除术的患者。人口统计学和癌症相关变量被提取，并使用回归模型确定SFM的预测因子。此后,随机选择20例SFM患者和20例无SFM患者，并对其术前CT扫描进行审查。放射学指数定义为1/(乙状结肠长度/骨盆深度)。使用ROC曲线分析确定预测SFM的最佳临界值。
结果：纳入了524例患者。121例患者（27.8%）进行SFM，手术时间延长21.8min（95%CI：11.3～32.4，p<0.001）。有或没有SFM的患者术后并发症的发生率没有差异。吻合的实现是SFM的主要预测因子(OR:42.4,95%CI:5.8至308.5,p<0.001)。在结直肠吻合的患者中，两个乙状结肠长度（15±5.1cm与24.2±80.9cm，p<0.001）和放射学指数（1±0.3对0.6±0.2，p<0.001）在患有SFM的患者和未患有SFM的患者之间存在差异。放射学指标的ROC曲线分析表明最佳临界值为0.8（灵敏度：75％，特异性：90%）。
结论：在27.8%的机器人前切除术患者中进行了SFM，手术时间延长21.8min。为了优化手术计划，需要SFM的患者可以根据术前CT使用指数1/(乙状结肠长度/骨盆深度)进行识别,截断值设定为0.8.
方法：从前瞻性登记中确定接受机器人直肠癌前切除术的患者。人口统计学和癌症相关变量被提取，并使用回归模型确定SFM的预测因子。此后,随机选择20例SFM患者和20例无SFM患者，并对其术前CT扫描进行审查。放射学指数定义为1/(乙状结肠长度/骨盆深度)。使用ROC曲线分析确定预测SFM的最佳临界值。
结果：纳入了524例患者。121例患者（27.8%）进行SFM，手术时间延长21.8min（95%CI：11.3～32.4，p<0.001）。有或没有SFM的患者术后并发症的发生率没有差异。吻合的实现是SFM的主要预测因子(OR:42.4,95%CI:5.8至308.5,p<0.001)。在结直肠吻合的患者中，两个乙状结肠长度（15±5.1cm与24.2±80.9cm，p<0.001）和放射学指数（1±0.3对0.6±0.2，p<0.001）在患有SFM的患者和未患有SFM的患者之间存在差异。放射学指标的ROC曲线分析表明最佳临界值为0.8（灵敏度：75％，特异性：90%）。
结论：在27.8%的机器人前切除术患者中进行了SFM，手术时间延长21.8min。为了优化手术计划，需要SFM的患者可以根据术前CT使用指数1/(乙状结肠长度/骨盆深度)进行识别,截断值设定为0.8.
