Highlights
- •Surgical treatment of splenic flexure colon cancer remains controversial regarding extent of colon resection.
- •Dual lymphatic drainage in splenic flexure enquiries optimal extent of surgical resection and mesenteric vascular ligation.
- •The overall and disease free survival were similar for extended and segmental colonic resection groups.
Abstract
Background
The optimal surgical treatment approach for splenic flexure colon cancers remains
controversial regarding the type of resection.
Methods
We hypothesized that both extended and segmental resections have similar surgical
and oncologic outcomes. A retrospective review of prospectively collected database
was performed on all patients who had colectomy for splenic flexure colon cancer between
1996 and 2018.
Results
Of 142 patients, 119 underwent extended resection; therefore, this group was compared
with the group which underwent segmental resection (n = 23). The groups were similar
in age, sex, ASA scores, operative times, estimated blood loss, hospital length of
stay, and postoperative complication rates (p > 0.05). Median follow-up was 9.58 years
(IQR:5.46–16.48). Multivariable regression models demonstrated no significant association
between resection approach and disease-free survival (HR 1.63 [95%CI:0.91–2.92]),
as well as overall survival (HR 1.80 [95%CI:0.97; 3.36]).
Conclusion
In the treatment of splenic flexure colon cancer, segmental colon resections have
similar oncologic outcomes when compared to extended colectomies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the global burden of disease study 2019.JAMA Oncol. 2022; 8 (Global): 420-444https://doi.org/10.1001/jamaoncol.2021.6987
- Survival after resection of carcinoma of the splenic flexure.Dis Colon Rectum. 1991; 34: 401-403https://doi.org/10.1007/BF02053691
- Evaluation of the vascular anatomy of the left-sided colon focused on the accessory middle colic artery: a single-centre study of 734 patients.Colorectal Dis. 2018; 20: 1041-1046https://doi.org/10.1111/codi.14287
- Lymph node metastases in splenic flexure colon cancer: is subtotal colectomy warranted?.J Surg Oncol. 2018; 118: 1027-1033https://doi.org/10.1002/jso.25169
- Propensity score analysis of postoperative and oncological outcomes after surgical treatment for splenic flexure colon cancer.Int J Colorectal Dis. 2018; 33: 1201-1213https://doi.org/10.1007/s00384-018-3063-1
- Is segmental colon resection an alternative treatment for splenic flexure cancer?.J Laparoendosc Adv Surg Tech. 2019; 29: 621-626https://doi.org/10.1089/lap.2019.0041
- Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: experience of a high volume cancer center.Sci Rep. 2019; 9 (Published 2019 Jul 29)10953https://doi.org/10.1038/s41598-019-47548-z
- Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis.Surg Endosc. 2021; 35: 661-672
- 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
- Surgical anatomy of the blood supply of the distal colon.Ann R Coll Surg Engl. 1956; 19: 241-256
- Lymphatic drainage of the splenic flexure defined by intraoperative scintigraphic mapping.Dis Colon Rectum. 2018; 61: 441-446
- Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure.Surg Today. 2001; 31: 204-209
- Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life.Dis Colon Rectum. 2008; 51: 1036-1043
Article info
Publication history
Published online: November 15, 2022
Accepted:
November 10,
2022
Received in revised form:
October 30,
2022
Received:
July 10,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
☆This study was accepted as part of an oral presentation with an invited discussant at MSA 2022 Annual Meeting on August 7–9, 2022 at Grand Hotel, Mackinac Island, Michigan.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
