{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:14:47Z","timestamp":1766067287329,"version":"3.41.2"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":46,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["16K07143","16K07161","17K10620","17K10621","17K10623","18K07194"],"award-info":[{"award-number":["16K07143","16K07161","17K10620","17K10621","17K10623","18K07194"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2009&amp;lt;\u20090.001), older age (P\u2009=\u20090.004) and increased bodyweight (P\u2009=\u20090.043) 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\u00a0min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2\u00a0min respectively; P\u2009=\u20090.006).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraa040","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T12:54:45Z","timestamp":1613652885000},"source":"Crossref","is-referenced-by-count":8,"title":["Classification of the colonic splenic flexure based on three-dimensional CT analysis"],"prefix":"10.1093","volume":"5","author":[{"given":"K","family":"Kawai","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Nozawa","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4064-8701","authenticated-orcid":false,"given":"K","family":"Hata","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Faculty of Medicine, University of Tokyo , Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,15]]},"reference":[{"key":"2022070913404725800_zraa040-B1","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1007\/DCR.0b013e3181e5e0b1","article-title":"Intraoperative technical difficulty during laparoscopy-assisted surgery as a prognostic factor for colorectal cancer","volume":"53","author":"Kang","year":"2010","journal-title":"Dis Colon Rectum"},{"key":"2022070913404725800_zraa040-B2","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1007\/s00464-010-1039-5","article-title":"Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer","volume":"24","author":"Akiyoshi","year":"2010","journal-title":"Surg Endosc"},{"key":"2022070913404725800_zraa040-B3","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1111\/j.1463-1318.2011.02927.x","article-title":"The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections","volume":"14","author":"Marsden","year":"2012","journal-title":"Colorectal Dis"},{"key":"2022070913404725800_zraa040-B4","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s00464-014-3774-5","article-title":"Does laparoscopy reduce splenic injuries during colorectal resections? 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