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The optimal extent of colectomy for splenic flexure carcinoma - Extended vs segmental? Less is best!

Published:November 14, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.054
The optimal extent of colectomy for splenic flexure carcinoma - Extended vs segmental? Less is best!
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      The debate regarding the optimal operation for splenic flexure carcinoma (SFC)

      Ozgur I, Liska D, Valente MA, et al. Best surgical approach for splenic flexure colon cancers: extended versus segmental resection? Am J Surg 2023; 225(3).

      has been stifled historically by low quality studies with small patient populations because SFC represents only 8% of colon cancers.
      • Levien D.H.
      • Gibbons S.
      • Begos D.
      • Byrne D.W.
      Survival after resection of carcinoma of the splenic flexure.
      Dis Colon Rectum. 1991; 34: 401-403
      Intraoperative scintigraphic mapping in subjects with normal splenic flexures revealed that lymphatics preferentially drain towards the left colic artery 96–97% of the time (rather than to left-sided branches of the middle colic artery).
      • Vasey C.E.
      • Rajaratnam S.
      • O'Grady G.
      • Hulme-Moir M.
      Lymphatic drainage of the splenic flexure defined by intraoperative scintigraphic mapping.
      Dis Colon Rectum. 2018; 61: 441-446
      Therefore, as an oncologic operation for SFC, segmental colectomy provides adequate lymphatic clearance and lymph node (LN) harvest.
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      References

      1. Ozgur I, Liska D, Valente MA, et al. Best surgical approach for splenic flexure colon cancers: extended versus segmental resection? Am J Surg 2023; 225(3).

        View in Article
        • Levien D.H.
        • Gibbons S.
        • Begos D.
        • Byrne D.W.
        Survival after resection of carcinoma of the splenic flexure.
        Dis Colon Rectum. 1991; 34: 401-403
        View in Article
        • Vasey C.E.
        • Rajaratnam S.
        • O'Grady G.
        • Hulme-Moir M.
        Lymphatic drainage of the splenic flexure defined by intraoperative scintigraphic mapping.
        Dis Colon Rectum. 2018; 61: 441-446
        View in Article
        • Nakagoe T.
        • Sawai T.
        • Tsuji T.
        • et al.
        Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure.
        Surg Today. 2001; 31: 204-209
        View in Article
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        • Alves A.
        • Meillat H.
        • et al.
        What is the optimal elective colectomy for splenic flexure cancer: end of the debate? A multicenter study from the GRECCAR Group with a propensity score analysis.
        Dis Colon Rectum. 2022; 65: 55-65
        View in Article
        • You Y.N.
        • Chua H.K.
        • Nelson H.
        • Hassan I.
        • Barnes S.A.
        • Harrington J.
        Segmental vs. extended colectomy: measurable differences in morbidity, function and quality of life.
        Dis Colon Rectum. 2008; 51: 1036-1043
        View in Article
        • Feinstein A.R.
        • Sosin D.M.
        • Wells C.K.
        The Will Rogers phenomenon: stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer.
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        View in Article

      Article info

      Publication history

      Published online: November 14, 2022
      Accepted: October 25, 2022
      Received: October 24, 2022

      Publication stage

      In Press Journal Pre-Proof

      Identification

      DOI: https://doi.org/10.1016/j.amjsurg.2022.10.054

      Copyright

      © 2022 Elsevier Inc. All rights reserved.

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