{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:52:48Z","timestamp":1767495168729,"version":"3.37.3"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006389","name":"University of Geneva","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006389","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Five hundred and twenty-four patients were included. SFM was performed in 121 patients (27.8%) and increased operative time by 21.8\u00a0min (95% CI: 11.3 to 32.4, p\u2009&lt;\u20090.001). 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\u2009&lt;\u20090.001). In patients with colorectal anastomosis, both sigmoid length (15\u2009\u00b1\u20095.1\u00a0cm versus 24.2\u2009\u00b1\u200980.9\u00a0cm, p\u2009&lt;\u20090.001) and radiological index (1\u2009\u00b1\u20090.3 versus 0.6\u2009\u00b1\u20090.2, p\u2009&lt;\u20090.001) 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%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>SFM was performed in 27.8% of patients who underwent robotic anterior resection, and increased operative time by 21.8\u00a0min. 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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00464-023-10008-x","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T14:03:00Z","timestamp":1680530580000},"page":"5388-5396","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Predictors for selective flexure mobilization during robotic anterior resection for rectal cancer: a prospective cohort analysis"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-9146","authenticated-orcid":false,"given":"Jeremy","family":"Meyer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"van der Schelling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Wijsman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Ris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rogier","family":"Crolla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"10008_CR1","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1055\/s-0042-1743583","volume":"35","author":"R Crolla","year":"2022","unstructured":"Crolla R, Coffey JC, Consten EJC (2022) The mesentery in robot-assisted total mesorectal excision. Clin Colon Rectal Surg 35:298\u2013305","journal-title":"Clin Colon Rectal Surg"},{"key":"10008_CR2","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1111\/codi.13843","volume":"19","author":"G Dapri","year":"2017","unstructured":"Dapri G, Bascombe NA, Cadiere GB et al (2017) The three approaches to the colonic splenic flexure mobilization - a video vignette. Colorectal Dis 19:948\u2013949","journal-title":"Colorectal Dis"},{"key":"10008_CR3","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1007\/s10151-012-0930-6","volume":"17","author":"S Thum-umnuaysuk","year":"2013","unstructured":"Thum-umnuaysuk S, Boonyapibal A, Geng YY et al (2013) Lengthening of the colon for low rectal anastomosis in a cadaveric study: how much can we gain? Tech Coloproctol 17:377\u2013381","journal-title":"Tech Coloproctol"},{"key":"10008_CR4","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1007\/s13304-021-01135-y","volume":"73","author":"F Rondelli","year":"2021","unstructured":"Rondelli F, Pasculli A, De Rosa M et al (2021) Is routine splenic flexure mobilization always necessary in laparotomic or laparoscopic anterior rectal resection? A systematic review and comprehensive meta-analysis. Updates Surg 73:1643\u20131661","journal-title":"Updates Surg"},{"key":"10008_CR5","doi-asserted-by":"publisher","first-page":"392","DOI":"10.3390\/jcm7110392","volume":"7","author":"M Nowakowski","year":"2018","unstructured":"Nowakowski M, Malczak P, Mizera M et al (2018) The safety of selective use of splenic flexure mobilization in sigmoid and rectal resections-systematic review and meta-analysis. 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