Lymphatic Drainage of the Splenic Flexure Defined by Intraoperative Scintigraphic Mapping

BACKGROUND: The optimal surgical management of splenic flexure cancer is debated, partly because of an incomplete understanding of the lymphatic drainage of this region. OBJECTIVE: This study aimed to evaluate the normal lymphatic drainage of the human splenic flexure using laparoscopic scintigraphic mapping. DESIGN: This was a clinical trial. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: Thirty consecutive patients undergoing elective colorectal resections without splenic flexure pathology were recruited. INTERVENTION: Technetium-99m was injected subserosally at the splenic flexure. MAIN OUTCOME MEASURES: Lymphatic scintigraphic mapping was undertaken at 15, 30, and 60 minutes using a laparoscopic gamma probe at the left branch of the middle colic, left colic, inferior mesenteric, and ileocolic (control) lymphovascular pedicles. RESULTS: Lymphatic drainage at 60 minutes was strongly dominant in the direction of the left colic pedicle (96% of patients), with a median gamma count of 284 (interquartile range, 113–413), versus the left branch of the middle colic count of 31 (interquartile range, 15–49; p

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