Splenic Flexure Mobilisation for Anterior Resection Performed for Sigmoid and Rectal Cancer

Traditional teachingi nc olorectal cancer surgeryi st hat splenic flexure mobilisation accompanied by ligation of the inferior mesenteric artery at its origina re mandatoryt o achieve as atisfactoryo utcome, judged not only in the shortterm by patient recovery but also in the long-termbyoncological results.As with all aspects of surgery,the logicbehind this teaching needs re-appraisalinthe cold light of evidence rather than beingobscured by the shadows of prejudice and tradition.The issues for debate are, first whether ligation of the inferior mesenteric artery at its origin, flush on the aorta, improves cancer outcomes, thus decreasing local or distant recurrence?Second,issplenic flexuremobilisation necessary to ensure aw ell-vascularised anastomosis without tension?We examine these points with reference to the facts underpinning the debate. Does inferiormesenteric artery originligation improvep rognosis?In some of the largest reports to date, there is no evidence that high ligation confers an oncologicala dvantage.Pezim and Nicholls 1 analysed 567 Dukes' Cp atients treated at St Mark'sHospital, reporting no improvement in survival with proximal ligation.Surtees et al. 2 reported 250 patients from the same institution, 60% of whom had undergone inferior mesenteric artery ligation above the ascending left colic artery.