Clinical Scorecard: Adapted Rosi–Cahill Approach Following Left Extended Colectomy for Advanced Tumors of the Splenic Flexure

At a Glance

Key Highlights

• Splenic flexure colon cancer is rare (2–5% of colon cancers) and prone to obstruction, serosal infiltration, mucinous histology, and peritoneal carcinomatosis relapse.
• Complete mesocolic excision (CME) improves lymph node yield, reduces recurrence, and enhances survival compared to non-CME segmental resections.
• The adapted Rosi–Cahill technique allows tension-free anastomosis without mesenteric vessel torsion or mesenteric windows, avoiding complications seen with Deloyers’ procedure.

Guideline-Based Recommendations

Diagnosis

• Identify splenic flexure tumors with imaging and histopathology noting risk of stenosis and serosal infiltration.
• Assess extent of lymphatic drainage and vascular supply to guide resection margins.

Management

• Perform extended left colectomy including middle colic and inferior mesenteric vessel ligation for advanced tumors.
• Adhere to complete mesocolic excision principles to remove mesocolon en bloc for oncologic radicality.
• Use the adapted Rosi–Cahill technique for reconstruction to preserve right colon and avoid vessel torsion.

Monitoring & Follow-up

• Monitor for anastomotic integrity given higher leak risk in segmental resections.
• Follow-up for cancer recurrence, especially peritoneal carcinomatosis.

Risks

• Anastomotic leak due to inadequate blood supply at Griffiths’ point.
• Internal hernia and mesenteric torsion risks associated with Deloyers’ technique if performed incorrectly.
• Long-term bowel dysfunction and quality of life deterioration after total colectomy due to ileocecal valve loss.

Patient & Prescribing Data

Patients undergoing surgery for advanced splenic flexure colon cancer

Preserving right colon with Rosi–Cahill technique reduces bowel dysfunction and avoids complications related to vessel torsion seen in alternative reconstructions.

Clinical Best Practices

• Ensure at least 10 cm of colon resection from tumor edge based on vascular lymphatic drainage.
• Divide both middle colic and inferior mesenteric vessels centrally in advanced splenic flexure tumors.
• Perform right medial visceral rotation (Cattell–Braasch maneuver) for adequate mobilization in Rosi–Cahill technique.
• Systematically remove appendix during reconstruction due to complexity of future appendectomy.
• Avoid clockwise rotation in Deloyers’ technique to prevent mesenteric window and internal hernia.

References

• Splenic flexure colon cancer characteristics and obstruction risk
• International study on splenic flexure colon cancer pathology and relapse
• Total colectomy considerations in peritoneal carcinomatosis
• Deloyers’ procedure original description
• Complete mesocolic excision concept by Hohenberger et al.
• Rosi–Cahill technique original description