Adapted Rosi–Cahill Approach After Left Extended Colectomy for Splenic Flexure Tumors

Overview

Splenic flexure colon cancer, though rare, presents surgical challenges due to its location and vascular supply. The adapted Rosi–Cahill technique offers a tension-free colorectal anastomosis without mesenteric vessel torsion or windows, contrasting with the commonly used Deloyers’ procedure. This approach may reduce complications such as internal hernias and preserve bowel function better.

Background

Splenic flexure colon cancer accounts for 2–5% of colon cancers and is prone to obstruction and aggressive features like serosal infiltration and mucinous histology. Extended left colectomy with complete mesocolic excision (CME) including middle colic and inferior mesenteric vessels is recommended for oncologic radicality. Reconstruction after such resections is challenging due to the need for tension-free anastomosis and preservation of bowel function. Deloyers’ technique, involving 180° rotation of the right colon, is popular but can cause mesenteric vessel torsion and internal hernias. The Rosi–Cahill technique, described earlier, avoids these issues by an anticlockwise rotation without vessel torsion or mesenteric windows.

Data Highlights

Splenic flexure colon cancer represents 2–5% of all colon cancers. Segmental resections have higher anastomotic leak rates and lower lymph node yields compared to CME. Deloyers’ technique involves 180° counterclockwise rotation of the right colon, risking mesenteric torsion and internal hernias if performed incorrectly. The Rosi–Cahill technique involves anticlockwise rotation without vessel torsion or mesenteric windows, preserving the right colon and avoiding these complications.

Key Findings

• Splenic flexure tumors require extended left colectomy with central ligation of middle colic and inferior mesenteric vessels for oncologic radicality.
• Deloyers’ procedure involves 180° counterclockwise rotation of the right colon but risks mesenteric vessel torsion and internal hernias if rotated clockwise.
• The Rosi–Cahill technique, described in 1960, uses anticlockwise rotation of the right colon without vessel torsion or mesenteric windows.
• Rosi–Cahill requires more extensive dissection but avoids complications related to mesenteric torsion and internal hernias seen with Deloyers’ technique.
• Preservation of the ileocecal valve and right colon with Rosi–Cahill may improve postoperative bowel function and quality of life.
• Misidentification and confusion between Rosi–Cahill and Deloyers’ techniques in literature may affect surgical decision-making.

Clinical Implications

Surgeons performing extended left colectomies for advanced splenic flexure tumors should consider the adapted Rosi–Cahill technique to achieve tension-free colorectal anastomosis without mesenteric vessel torsion. This approach may reduce the risk of internal hernias and preserve bowel function by maintaining the ileocecal valve. Awareness of the differences between Rosi–Cahill and Deloyers’ procedures is essential to optimize surgical outcomes.

Conclusion

The adapted Rosi–Cahill technique offers a safe and effective reconstructive option after extended left colectomy for splenic flexure tumors, avoiding the pitfalls of vessel torsion and mesenteric windows inherent to Deloyers’ procedure. Its use may improve postoperative outcomes and quality of life.

References

1. Hohenberger et al. 2009 -- Complete mesocolic excision in colon cancer surgery
2. Dumont et al. 2020 -- Pitfalls of Deloyers’ procedure and internal hernia risk
3. Rosi and Cahill 1960 -- Cecorectal anastomosis technique
4. International study on splenic flexure colon cancer characteristics