{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:56:28Z","timestamp":1777938988998,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004886","name":"Cancer Research Foundation in Northern Sweden","doi-asserted-by":"publisher","award":["AMP 19-978"],"award-info":[{"award-number":["AMP 19-978"]}],"id":[{"id":"10.13039\/501100004886","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007687","name":"Svenska Lakaresallskapet","doi-asserted-by":"publisher","award":["SLS-934594"],"award-info":[{"award-number":["SLS-934594"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009336","name":"Bengt Ihres Foundation","doi-asserted-by":"publisher","award":["SLS-934603"],"award-info":[{"award-number":["SLS-934603"]}],"id":[{"id":"10.13039\/501100009336","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["CAN 2018\/589"],"award-info":[{"award-number":["CAN 2018\/589"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004063","name":"Knut och Alice Wallenbergs Stiftelse","doi-asserted-by":"publisher","award":["RV-762241"],"award-info":[{"award-number":["RV-762241"]}],"id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Surg"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objective:<\/jats:title>\n                    <jats:p>Some colorectal surgeons advocate routine splenic flexure mobilization (SFM) when performing anterior resection for rectal cancer to ensure a tension-free anastomosis. Meta-analyses of smaller studies suggest that this approach does not influence anastomotic leakage rates, but larger multicentre studies are needed to confirm the safety of a selective strategy. The aim of this study is to evaluate the impact of SFM on anastomotic leakage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a retrospective multicentre cohort study, comprising 1109 patients operated with anterior resection for rectal cancer in 2014\u20132018. Exposure was SFM, while anastomotic leakage within a year constituted the outcome. Stratified analyses were performed for type of mesorectal excision and surgical approach, as well as sensitivity analysis considering vascular tie placement. Multivariable Cox regression with hazard ratios (HRs) and 95% confidence intervals (CIs) was employed to adjust for confounding, while multiple imputation was used for missing data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>SFM was performed in 381 patients (34.4%). Anastomotic leakage occurred in 83 (21.8%) and 123 (20.3%) patients operated with and without SFM, respectively. SFM was neither clearly detrimental nor beneficial regarding anastomotic leakage (adjusted HR = 0.82; 95% CI: 0.59\u20131.15), with no apparent differences for total or partial mesorectal excision and minimally invasive or open surgery. Concurrent high vascular ligation did not impact these results, and there was no evidence of interaction from centers with a more common use of SFM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>SFM did not seem to influence the risk of anastomotic leakage after anterior resection for rectal cancer, regardless of type of mesorectal excision, use of minimally invasive surgery, or high vascular ligation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14574969231181222","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T04:37:01Z","timestamp":1694061421000},"page":"246-255","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Splenic flexure mobilization and anastomotic leakage in anterior resection for rectal cancer: A multicentre cohort study"],"prefix":"10.1177","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0974-6373","authenticated-orcid":false,"given":"Martin","family":"Ruteg\u00e5rd","sequence":"first","affiliation":[{"name":"Department of Surgical and Perioperative Sciences, SurgeryUme\u00e5 UniversitySE-901 85 Ume\u00e5SwedenWallenberg Centre for Molecular MedicineUme\u00e5 UniversityUme\u00e5Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8601-0159","authenticated-orcid":false,"given":"Johan","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Statistics, Ume\u00e5 School of Business, Economics and Statistics, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josefin","family":"Segelman","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Surgery, Ersta Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Matthiessen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Louise","family":"Lydrup","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sk\u00e5ne University Hospital and Lund University, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9602-475X","authenticated-orcid":false,"given":"Jennifer","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 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