Inferior Mesenteric Artery First Combined With Complete Medial Approach for Laparoscopic Splenic Flexure Mobilization in Left Sided Colorectal Cancer

The aim of the study to compare surgical outcomes between inferior mesenteric artery first with complete medial approach and other traditional techniques in laparoscopic left sided colorectal cancer .

Study Overview

• Status: Not yet recruiting
• Conditions: Laparoscopic Splenic Flexure Mobilization
• Intervention / Treatment: Procedure: laparscopic splenic flexure mobilization

Detailed Description

Laparoscopic left-sided colon cancer radical resection is primarily employed for the treatment of tumors located in distal transverse colon , splenic flexure of colon, descending colon, and proximal segment of the sigmoid colon. Numerous factors impact the difficulty of surgery, with research suggesting that mobilization of the splenic flexure independently predicts longer operative times in laparoscopic left-sided colon cancer radical resection . Splenic flexure mobilization is independently associated with an increased risk of splenic injury, which contributes to elevated short-term and long-term mortality risks in patients. The crucial aspect of radical surgery is complete mesocolic excision (CME) with central vascular ligation and the Japanese D3 lymphadenectomy. For tumors located in descending colon and sigmoid-descending junction, the lymph node dissection range includes the central lymph node group (No.253) at the root of the inferior mesenteric artery (IMA) . In cases of cancer in the left half of the transverse colon or in the splenic flexure of colon, in addition to IMA root lymph node dissection, it is imperative to perform dissection of lymph nodes (No.223) at the root of the middle colic artery (MCA).Therefore, for laparoscopic left-sided colon cancer radical resection, ensuring the safety of splenic flexure mobilization and maintaining the quality of lymph nodes dissection are both crucial.

Currently, traditional surgical approaches for laparoscopic left-sided colon cancer radical resection include the medial approach, lateral approach, anterior approach, and various combinations of these methods. Due to variations in anatomical understanding, many teams propose the combined application of multiple approaches, each demonstrating a certain level of safety and feasibility.

• Study Type: Interventional
• Enrollment (Estimated): 68
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: omar mohamed doctor, master; Phone Number: +0201025104556; Email: Omar_Mokbel@aun.edu.eg
• Study Contact Backup: Name: momen shalkamy abdelgwad, phd; Phone Number: 01017520093; Email: moamen.shalkamy@aun.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Patients aged 18-70 years old with confirmed colorectal cancer diagnosis by histopathology with obligatory splenic flexure mobilization and had laparoscopic surgery with curative intent were included.

Exclusion Criteria:

• Those younger than 18 years or older than 70 years.
• Those undergoing non-cancer resections, or completion surgery or palliative procedures.
• Those with locally advanced ( extra colonic extension ) or metastatic tumors.
• Those with advanced comorbidities ( laparoscopy is contraindicated )

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: inferior mesenteric artery first with complete medial approach	Procedure: laparscopic splenic flexure mobilization; The patient was positioned in the modified lithotomy position with the main surgeon standing in between the abducted legs. The patient's head is lowered by 15° (Trendelenburg position), and table was 20° right-tilted. The position was adjusted at the time of splenic flexure mobilization to head elevation by 20° to let the small bowel go down toward the pelvis. Five ports were introduced [Figure 1]: a 10-mm port in the midline 4 cm above the umbilicus to increase the field of view, a second 5 mm port in the right midclavicular line just below the umbilicus, a third 10-12-mm port at the right midclavicular line in the right iliac fossa, a fourth 5-mm port in the left midclavicular line 2 cm above the level of the umbilicus, and a last 5-mm port in the midline 4 cm above the pubic bone. Port sites for laparoscopic left colectomy. The tumor was localized by either visual inspection or intraoperative colonoscopy. The summit of sigmoid colon was then pulled anteriorly with a grasper toward
Active Comparator: lateral approach	Procedure: laparscopic splenic flexure mobilization; The patient was positioned in the modified lithotomy position with the main surgeon standing in between the abducted legs. The patient's head is lowered by 15° (Trendelenburg position), and table was 20° right-tilted. The position was adjusted at the time of splenic flexure mobilization to head elevation by 20° to let the small bowel go down toward the pelvis. Five ports were introduced [Figure 1]: a 10-mm port in the midline 4 cm above the umbilicus to increase the field of view, a second 5 mm port in the right midclavicular line just below the umbilicus, a third 10-12-mm port at the right midclavicular line in the right iliac fossa, a fourth 5-mm port in the left midclavicular line 2 cm above the level of the umbilicus, and a last 5-mm port in the midline 4 cm above the pubic bone. Port sites for laparoscopic left colectomy. The tumor was localized by either visual inspection or intraoperative colonoscopy. The summit of sigmoid colon was then pulled anteriorly with a grasper toward

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
evaluation of safety and effectiveness of inferior mesenteric artery first in combination with complete medial approach in splenic mobilization in left sided colorectal cancer .	number of harvested lymph nodes	6 month

Collaborators and Investigators

• Sponsor: Assiut University

Publications and helpful links

General Publications

• Lee YS. Three Surgical Approaches of Laparoscopic Splenic Flexure Mobilization. J Minim Invasive Surg. 2019 Jun;22(2):85-86. doi: 10.7602/jmis.2019.22.2.85. Epub 2019 Jun 15.

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): May 1, 2029
• Study Completion (Estimated): May 1, 2029

Study Registration Dates

• First Submitted: May 24, 2026
• First Submitted That Met QC Criteria: June 13, 2026
• First Posted (Actual): June 18, 2026

Study Record Updates

• Last Update Posted (Actual): June 18, 2026
• Last Update Submitted That Met QC Criteria: June 13, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: laparoscopic colorectal cancer

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No