Splenic Flexure Cancer: Segmental Colonic Resection, Left Hemicolectomy, Extended Right Hemicolectomy or Total Colectomy? Short-Term and Long-Term Outcomes

Abstract

Introduction: Splenic flexure tumors are quite rare, accounting for 2% to 8% of all colorectal cancers. The heterogeneity of the vascular support and lymphatic drainage of the splenic flexure make the surgical management complex and non-standardized. The aim of the study is to compare the four surgical techniques (extended right hemicolectomy, left hemicolectomy, segmental colonic resection, and total colectomy) in terms of short-term and long-term outcomes.Materials and Methods: Consecutive patients from two hospitals of Turin (the Martini hospital and the San Giovanni Bosco hospital) between September 1998 and March 2020 have surgical visit for splenic flexure cancer. The data reported in the database include preoperative, postoperative, histopathological characteristics, and survival results. Univariate and multivariate analysis are performed to evaluate the confounding factors influencing overall and disease-free survival.Results and Discussion: A total of 173 patients treated for splenic flexure tumors are included in the study. The four groups are similar on the baseline characteristics of the patients. Clavien Dindo ≥ 3 postoperative complications and 30-day mortality are comparable in the four groups (p=0.216 e p=0.213). Five-year overall survival and progression-free survival did not show significant differences between the four surgical techniques (p=1.08 e p=0.28). No statistically significant differences were found between the four groups for baseline patient characteristics, intraoperative outcomes, postoperative complications, and TNM staging.Conclusion: Segmental colonic resection, extended right hemicolectomy, left hemicolectomy and total colectomy show no significant difference in short-term and oncological outcomes in cancer of the splenic flexure. Further studies with a higher level of evidence are needed.