Modified Rosi–Cahill technique after left extended colectomy for splenic flexure advanced tumors

TL;DR

This paper introduces a modified surgical technique to improve outcomes and quality of life for patients with advanced splenic flexure colon cancer.

Contribution

A modified Rosi–Cahill technique is proposed to avoid complications and improve postoperative quality of life after left extended colectomy.

Findings

The modified Rosi–Cahill technique reduces small bowel bacterial overgrowth and improves stool consistency.

The technique avoids mesenteric windows and torsion of ileocolic vessels, which are potential pitfalls in other procedures.

A video demonstrates the proper execution of the modified Rosi–Cahill technique and highlights potential surgical pitfalls.

Abstract

Advanced splenic flexure tumors are uncommon and have a higher risk of relapse. To ensure that the resection includes the entire area of lymphatic drainage with a complete mesocolic excision (CME), a left extended colectomy is needed. In peritoneal carcinomatosis, there is often extensive involvement of the sigma and splenic flexure of the colon. In many instances, total colectomies are chosen for these patients, even when a significant portion of the colon could be preserved. The potential impact on quality of life after splenic flexure colon resection is discussed, as well as the importance of anatomical knowledge and expertise in performing this type of surgery. Overall, this work presents a modified technique that aims to improve the outcomes and quality of life for patients with splenic flexure colon cancer. Creating a tension-free anastomosis after extended left-sided colorectal resection is challenging. There is a negative impact on quality of life when an ileorectal anastomosis is created. The colorectal anastomosis performed after modified Rosi–Cahill or Deloyers’ technique allows reduced small bowel bacterial overgrowth, achieves better water and sodium absorption, and altogether permits improved stool consistency. There are potential advantages of the Rosi–Cahill technique over other popular options such as Deloyers’ procedure as there is no torsion of the ileocolic vessels and no mesenteric windows. A video was recorded showing a potential pitfall during Deloyers’ technique resulting in the creation of a mesenteric window. The proper rotation of the colon during the modified Rosi–Cahill procedure was also filmed. Overall, this work presents a modified technique for reconstruction after left extended colectomy that aims to improve the outcomes and quality of life for patients with splenic flexure colon cancer.

The online version contains supplementary material available at 10.1007/s10151-024-02956-w.

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