Abstract
BackgroundThe effectiveness of surgical treatment for splenic flexure carcinomas (SFCs) in emergency settings remains unexplored. This study aims to compare the perioperative and long-term outcomes of different alternatives for emergency SFC resection.MethodThis multicenter retrospective study was based on the SFC Study Group database. For the present analysis, SFC patients were selected if they had received emergency surgical resection with curative intent between 2000 and 2018. Extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC) were evaluated and compared.ResultsThe study sample was composed of 90 SFC patients who underwent emergency ERC (n = 55, 61.1%), LC (n = 18, 20%), or SLC (n = 17, 18.9%). Bowel obstruction was the most frequent indication for surgery (n = 75, 83.3%), and an open approach was chosen in 81.1% of the patients. A higher incidence of postoperative complications was observed in the ERC group (70.9%) than in the LC (44.4%) and SLC groups (47.1%), with a significant procedure-related difference for severe postoperative complications (Dindo-Clavien ≥ III; adjusted odds ratio for ERC vs. LC:7.23; 95% CI 1.51-34.66; p = 0.013). Anastomotic leakage occurred in 8 (11.2%) patients, with no differences between the groups (p = 0.902). R0 resection was achieved in 98.9% of the procedures, and ≥ 12 lymph nodes were retrieved in 92.2% of patients. Overall and disease-free survival rates at 5 years were similar between the groups and were significantly associated with stage pT4 and the presence of synchronous metastases.ConclusionIn the emergency setting, ERC and open surgery are the most frequently performed procedures. ERC is associated with increased odds of severe postoperative complications when compared to more conservative SFC resections. Nonetheless, all the alternatives seem to provide similar pathologic and long-term outcomes, supporting the oncological safety of more conservative resections for emergency SFCs.
Highlights
The surgical treatment of splenic flexure carcinoma (SFC) has been traditionally neglected in the literature, mainly because of its relatively low incidence, as it represents only 3 to 5% of all colonic cancers [1,2,3,4]
extended right colectomy (ERC) is associated with increased odds of severe postoperative complications when compared to more conservative SFC resections
73 patients (81.1%) underwent open surgery; a higher frequency of laparoscopy was observed for left colectomy (LC) and segmental left colectomy (SLC) procedures than ERC, but the difference was not statistically significant (p = 0.051)
Summary
The surgical treatment of splenic flexure carcinoma (SFC) has been traditionally neglected in the literature, mainly because of its relatively low incidence, as it represents only 3 to 5% of all colonic cancers [1,2,3,4]. Despite a substantial lack of standardization regarding the nomenclature of the different surgical alternatives to resect SFCs, three main surgical procedures are performed, namely, extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC) [5, 14, 15]. All these procedures are considered alternatives for curative resections of these tumors, which are located on the border between the right and left colon and have dual lymphatic drainage toward the superior and inferior mesenteric vessels [16]. This study aims to compare the perioperative and long-term outcomes of different alternatives for emergency SFC resection
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