Use of thoracoabdominal incision for cancer of the splenic flexure in the obese patient

The thoracoabdominal incision is not a common incision in colonic surgery. However, it may be of unique benefit in tumors of the splenic flexure in which adequate mobilization and adequate lateral resection margins may otherwise be difficult to achieve. These tumors are believed to carry a poorer prognosis in part because of reduced accessibility. Specifically, exposure in short, obese patients with locally advanced lesions may be improved significantly with a thoracoabdominal incision. This report presents a patient with a tumor of the splenic flexure invading the diaphragm, greater curvature of the stomach, splenic hilum, and tail of the pancreas. The exposure provided by this incision made a radical cancer operation possible, which would not have been possible with an abdominal incision.