Classification of the colonic splenic flexure based on three-dimensional CT analysis
1Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo,Japan.
Insights
Classifying splenic flexure position using 3D coordinates helps predict surgical time. The lateral position is associated with significantly longer splenic flexure mobilization during colorectal surgery.
Area of Science:
- Colorectal Surgery
- Surgical Anatomy
- Medical Imaging
Background:
- Mobilizing the splenic flexure is a complex step in colorectal resections.
- Variability in splenic flexure anatomy presents surgical challenges.
- A standardized classification system is needed to predict mobilization difficulty.
Purpose of the Study:
- To classify the splenic flexure's anatomical position using 3D coordinates.
- To correlate splenic flexure position with surgical mobilization time.
- To improve preoperative planning in colorectal surgery.
Main Methods:
- Retrospective analysis of CT images from 319 colorectal cancer patients.
- Classification of splenic flexure position (caudal, cranial, lateral) using 3D coordinates of splenic and left renal hilum.
- Analysis of laparoscopic colectomy procedure times for complete splenic flexure mobilization.
Main Results:
- Three splenic flexure positions were identified: caudal (100), cranial (118), and lateral (101).
- Lateral position was independently associated with male sex, older age, and increased body weight.
- Mobilization time was significantly longer (78.7 min) in the lateral group compared to caudal (41.8 min) and cranial (43.2 min) groups.
Conclusions:
- Three-dimensional coordinate-based classification of splenic flexure anatomy is feasible.
- The lateral splenic flexure position predicts a significantly longer operative time for mobilization.
- This classification aids in anticipating and managing surgical complexity in colorectal procedures.
Background:
Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection.
Methods:
CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization.
Results:
Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex (P < 0.001), older age (P = 0.004) and increased bodyweight (P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006).
Conclusion:
Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.
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