Classification of the colonic splenic flexure based on three-dimensional CT analysis

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.