Flexure Tumors Research Articles

Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes.

The optimal extent of resection for splenic flexure adenocarcinoma remains debated. These tumours straddle the left- and right-sided vasculature with lymphatic drainage in a watershed area; current guidelines recommend either segmental or extended colectomy. We analysed surgical management of splenic flexure tumours and compared outcomes between approaches. The Surveillance, Epidemiology and End Results database was searched for adults with Stage I-III splenic flexure adenocarcinoma, 2004-2019. Of 5238 patients, 55% underwent extended colectomy. Compared to segmental colectomy, these patients were more likely to have advanced stage. On multivariable analysis, age ≤ 65 years remained independently associated with extended colectomy. Although fewer nodes were examined in segmental colectomy (median 14 vs. 16, p < 0.001), the number of positive nodes (both, median 0 [interquartile ratio 0-2], p = 0.20) and the lymph node ratio were similar between cohorts. Surgical approach was not significantly associated with increased positive nodal yield in adjusted analyses. Five-year overall and disease-specific survival were 73% and 84% for segmental and 72% and 83% for extended colectomy (p > 0.4); these remained comparable after adjustment. Nationally, we observed similar rates of segmental and extended colectomy for splenic flexure adenocarcinoma. Extended colectomy was not more common in Stage III disease, indicating lack of stage migration, and was not associated with better oncological outcomes. These observations support current practice involving either approach, which should be tailored to patient-related factors and preferences, while considering technical aspects and quality of life.

Extended procedure has no oncological benefits over segmental resection in the treatment of non-metastatic splenic flexure colon cancer, a population-based cohort study and a single center's decade-long experience.

To compare the oncological survival outcome between extended resections (ER) and segmental resection (SR) for non-metastatic splenic flexure tumors. A total of 10,063 splenic flexure colon cancers patients who underwent ER (n = 5546) or SR (n = 4517) from 2010 to 2018 were included from the Surveillance, Epidemiology, and End Results (SEER)-registered database. Additionally, we included 135 patients from our center who underwent ER (n = 54) or SR (n = 81) between 2011 and 2021. Survival rates were compared between groups. To reduce the inherent bias of retrospective studies, propensity score matching (PSM) analysis was performed. In the SEER database, patients in the ER group exhibited higher pT stage, pN stage, larger tumor size, and elevated rates of CEA level, perineural invasion, and tumor deposits compared to those in the SR group (each P < 0.05). The 5-year cancer-specific survival (CSS) rate was slightly lower in the ER group than in the SR group (79.2% vs. 81.6%, P = 0.002), while the 5-year overall survival (OS) rates were comparable between the two groups (66.2% vs. 66.9%, P = 0.513). After performing PSM, both the 5-year CSS and 5-year OS rates were comparable between the ER and SR groups (5-year CSS: 84.9% vs. 83.0%, P = 0.577; 5-year OS: 70.6% vs. 66.0%, P = 0.415). These findings were consistent in the subgroup analysis that included only patients with stage III disease or tumor size ≥ 7cm. Furthermore, although the number of harvested lymph nodes was higher in the ER group compared to the SR group (14.4 vs. 12.7, P < 0.001), the number of invaded lymph nodes remained similar between the two groups (0.5 vs. 0.5, P = 0.90). Similarly, our center's data revealed comparable 3-year OS and 3-year disease-free survival (DFS) rates between the two groups. ER have no significant oncological benefits over SR in the treatment of non-metastatic splenic flexure colon cancer, even for locally advanced cases.

Modified Rosi–Cahill technique after left extended colectomy for splenic flexure advanced tumors

Advanced splenic flexure tumors are uncommon and have a higher risk of relapse. To ensure that the resection includes the entire area of lymphatic drainage with a complete mesocolic excision (CME), a left extended colectomy is needed. In peritoneal carcinomatosis, there is often extensive involvement of the sigma and splenic flexure of the colon. In many instances, total colectomies are chosen for these patients, even when a significant portion of the colon could be preserved. The potential impact on quality of life after splenic flexure colon resection is discussed, as well as the importance of anatomical knowledge and expertise in performing this type of surgery. Overall, this work presents a modified technique that aims to improve the outcomes and quality of life for patients with splenic flexure colon cancer. Creating a tension-free anastomosis after extended left-sided colorectal resection is challenging. There is a negative impact on quality of life when an ileorectal anastomosis is created. The colorectal anastomosis performed after modified Rosi–Cahill or Deloyers’ technique allows reduced small bowel bacterial overgrowth, achieves better water and sodium absorption, and altogether permits improved stool consistency. There are potential advantages of the Rosi–Cahill technique over other popular options such as Deloyers’ procedure as there is no torsion of the ileocolic vessels and no mesenteric windows. A video was recorded showing a potential pitfall during Deloyers’ technique resulting in the creation of a mesenteric window. The proper rotation of the colon during the modified Rosi–Cahill procedure was also filmed. Overall, this work presents a modified technique for reconstruction after left extended colectomy that aims to improve the outcomes and quality of life for patients with splenic flexure colon cancer.

Surgical management of splenic flexure cancer: is there an optimal technique? A bi-national registry analysis.

Splenic flexure tumours (SFC) are uncommon and present at more advanced disease stages. The optimal surgical technique for SFC remains controversial. We sought to compare the short-term outcomes of a left hemicolectomy (LHC) versus an extended resection (subtotal colectomy, STC) for SFCs. A retrospective analysis using the Binational Colorectal Cancer Audit (BCCA) registry was performed. All patients with SFC who underwent elective or emergency surgery for a SFC between 2010 and 2021 were included. Primary outcomes included short-term inpatient complications. Secondary outcomes included survival outcomes. Six hundred and ninety-nine patients underwent resections for SFCs. A LHC was more common, performed in 64.1%. Patients having a LHC were significantly older, with proportionally more LHCs done laparoscopically. Overall grade III/IV complications were similar between both operations. Prolonged ileus and return to theatre were significantly higher in patients undergoing a STC. On multivariate analysis, anastomotic leak and overall grade III/IV complications were not independently associated with the type of operation. There was no difference in medial survival based on type of operation. Higher tumour stage (Stage III/IV) were independently associated with worse survival. Segmental and extended resections are both oncologically sound procedures for SFCs. Segmental resections are associated with lower rates of prolonged ileus.

Segmental and extended resections provide comparable survival for clinically node-negative splenic flexure cancer: a propensity score-matched analysis of the National Cancer Database.

There is an ongoing debate regarding the extent of resection for splenic flexure tumors (SFT). The purpose of this study was to compare segmental and extended resections in terms of overall survival (OS) and pathologic outcomes. Retrospective analysis of all patients surgically treated for SFT in the National Cancer Database (NCDB) for the period 2010-2019. Outcomes of segmental and extended resections were compared and a 1:1 propensity score matching was used to match for confounders. Primary outcome was OS. In total 3498/668,852 (0.5%) patients with clinical stageI-III splenic flexure adenocarcinoma in the NCDB were included. Of these, 1533 (43.8%) underwent segmental resection while 1965 (56.1%) underwent extended resection. After matching, mean OS was similar between the groups (92 vs 91months; p = 0.94). When survival was stratified by clinical Nstage, an 8-month survival benefit was shown in the extended resection group for clinical N-positive status (86 vs 78); however, this difference did not achieve statistical significance (p = 0.078). Median number of harvested lymph nodes was significantly lower in the segmental resection group (16 vs 17; p < 0.001) and the percentage of patients with fewer than 12 harvested nodes was significantly higher (18.4% vs 11.6%; p < 0.001). Length of stay was significantly shorter in the segmental resection group (5 vs 6days; p = 0.027). There were no significant differences between the groups in terms of 30-day readmission or 30- or 90-day mortality. While segmental and extended resections were associated with similar OS for clinically node-negative SFT, there might be a survival benefit for extended resection in patients with clinical evidence of lymph node involvement.

SAGES masters program: the top 10 seminal articles for the laparoscopic left and sigmoid colectomy pathway for complex disease.

The SAGES University Colorectal Masters Program is a structured educational curriculum that is designed to aid practicing surgeons develop and maintain knowledge and technical skills for laparoscopic colorectal surgery. The Colorectal Pathway is based on three anchoring procedures (laparoscopic right colectomy, laparoscopic left and sigmoid colectomy for uncomplicated and complex disease, and intracorporeal anastomosis for minimally invasive right colectomy) corresponding to three levels of performance (competency, proficiency and mastery). This manuscript presents focused summaries of the top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease. A systematic literature search of Web of Science for the most cited articles on the topic of laparoscopic complex left/sigmoid colectomy yielded 30 citations. These articles were reviewed and ranked by the SAGES Colorectal Task Force and invited subject experts according to their citation index. The top 10 ranked articles were then reviewed and summarized, with emphasis on relevance and impact in the field, study findings, strength and limitations and conclusions. The top 10 seminal articles selected for the laparoscopic left/sigmoid colectomy for complex disease anchoring procedure include advanced procedures such as minimally invasive splenic flexure mobilization techniques, laparoscopic surgery for complicated and/or diverticulitis, splenic flexure tumors, complete mesocolic excision, and other techniques (e.g., Deloyers or colonic transposition in cases with limited colonic reach after extended left-sided resection). The SAGES Colorectal Masters Program top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease anchoring procedure are presented. These procedures were the most essential in the armamentarium of practicing surgeons that perform minimally invasive surgery for complex left and sigmoid colon pathology.

Gastrocolic fistula caused by transverse colon cancer: a case report

BackgroundA gastrocolic fistula is an unusual communication between the colon and the stomach. Although colon cancer is the most common malignant cause of gastrocolic fistula in the Western world, the incidence of gastrocolic fistula due to colon cancer is 0.3% in operated cases.Case presentationA 68-year-old man presented with anorexia, general malaise, weight loss, and vomiting of fecal matter. Investigations revealed that the patient had a large nonmetastatic splenic flexure tumor that was diagnosed as colon cancer and had invaded the stomach and pancreas. An upper gastrointestinal series confirmed a gastrocolic fistula. Left hemicolectomy, distal gastrectomy, distal pancreatectomy, and splenectomy were performed. Histology revealed transverse colon cancer, which was UICC stage (8th edition) pT4bN1bcM0 pStage IIIC. Adjuvant chemotherapy was not performed. There was no recurrence or metastasis one year after surgery.We reviewed 17 cases including our case of a gastrocolic fistula caused by colon cancer. Neoadjuvant chemotherapy was not given to any of the patients, and en bloc resections were conducted in all cases. Adjuvant chemotherapy was given to almost all of the patients. There was no recurrence or metastasis.ConclusionsFor gastrocolic fistula caused by advanced colon cancer, secure en bloc surgical resection was the initial treatment in all 17 reported cases including the present case, and adjuvant chemotherapy may contribute to a better prognosis.

Short-term outcomes of subtotal colectomy for splenic flexure tumors: a single-center experience

Splenic flexure tumors are a subtype of colon tumors whose treatment is still debated. We aim to evaluate the surgical methods and short-term outcomes of splenic flexure tumors. Fourteen patients with colonic tumors at or near the splenic flexure who underwent subtotal colectomy in the surgical oncology department of Samsun Training and Research Hospital between August 2017 and March 2020 were retrospectively evaluated in terms of postoperative morbidity, mortality, and early oncologic outcomes. Of the fourteen patients evaluated, twelve were urgent and two were elective. Four patients underwent additional organ resection as a curative surgery. The pathology was colonic adenocarcinoma in all patients, and the histotype was mucinous in five patients (35.7%). Lymph node positivity was detected in six patients (42.8%) and metastasis in one patient (7.1%). Postoperatively, two patients (14.2%) developed surgical site infection, and one patient (7.1%) died. Eight (57.1%) patients complained of more frequent defecation, with a mean bowel movement frequency of 3±1.6 times daily. Based on our clinical experience, subtotal colectomy is appropriate for emergency surgical treatment of splenic flexure tumors, whereas left hemicolectomy is appropriate under elective conditions.

S2068 Malignant Colo-Duodenal Fistula in a Rare Anatomic Position

Introduction: The first case of malignant colo-duodenal fistula (MCDF) was reported in 1862 and since then only 70 MCDF cases had been reported. We describe a case of MCDF between the hepatic flexure and second part of the duodenum, a rarely observed anatomic location. Case Description/Methods: A 63-year-old male presented to an outside hospital with lethargy and a weight loss of 30 lbs over 3 months without any overt GI bleed and was found to be anemic. He had RUQ rebound tenderness and a positive stool occult blood test. A large duodenal ulcer was found on EGD that was concerning for malignancy. He was subsequently transferred to our hospital for further evaluation. CT abdomen showed a contrast-filled fistulous communication with associated circumferential wall thickening and luminal narrowing between the duodenum and the colon. Scattered noncalcified pulmonary nodules in both lungs were also observed. A repeat EGD showed a large, partially circumferential, friable ulcer in the first part of the duodenum with a fistulous tract connecting to the colon. A colonoscopy showed a fistulous tract with surrounding ulceration and adenomatous-appearing mucosa in the hepatic flexure of the colon connecting to the duodenum. The endoscope could not be advanced safely beyond the hepatic flexure due to edema around the fistulous tract. Pathology revealed invasive moderately differentiated adenocarcinoma with ulceration and detached fragments of small intestinal and colonic mucosa in the duodenal biopsies and invasive moderately differentiated adenocarcinoma with cells that were CK20+, SATB2+, and CK7− consistent with metastatic colorectal cancer in the colon biopsies. Surgical and medical oncology were consulted for management (Figure 1). Discussion: Most MCDF involve the second portion of the duodenum. In our patient, the fistula connected the first portion of the duodenum to the hepatic flexure of the colon. Although, 20% of hepatic flexure tumors are adherent to the duodenum, very few fistulate into it. Cross-sectional imaging with contrast studies help confirm and stage the primary tumor and fistulous tract by delineating extent of local invasion and evaluating for metastatic spread. Upper and lower endoscopy help demonstrate the fistulous communication and biopsy allows for a pathological diagnosis. Definitive treatment involves a surgical resection of the primary malignancy. However, but once the disease has progressed to point of fistulization or metastases, the overall prognosis is poor.Figure 1.: A, CT Abdomen with contrast showing colo-duodenal fistula (red arrow) B, EGD showing fistula in 2nd part of the duodenum (black arrow) and ulceration. C, Colonoscopy showing fistula (green arrow) in the hepatic flexure with ulceration and edema.

P-229 Comparison of clinicopathological and survival features of right and left colon cancers: Experience of the medical oncology department of Fez

Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) have different epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. The objective of our study is to compare right-sided colon cancers and left-sided colon cancers regarding clinicopathological and survival characteristics. This is a retrospective study of 664 patients with colon cancer treated at the medical oncology department of Fez over a period from December 2009 to September 2020. Rectosigmoid, descending colon, and splenic flexure tumors were considered left-sided colon cancers, whereas ascending colon tumors were considered right-sided colon cancers. The Kaplan Meier method was used to estimate median survival. The study included 664 patients (female, 47 %) having colon cancer with a median age of 60years [23-83]. Of the patients, 78.5% (n=519) had LCC and 19.36 % (n=128) had RCC. The rate of patients aged ≥65 years and the rate of patients with a family history of colon cancer were higher in the LCC patients. The proportion of poorly differentiated adenocarcinomas represented 3%, of which 63% had cancer of the right colon. There was a significantly higher proportion of higher T stage (T3-4 :62%vs 38 %) in right sided tumors as compared to left sided tumors. The rate of metastatic patients was 64.1% in the RCC group and 43% in the LCC group. The median follow-up period was 14 months in the RCC group and 19 months in the LCC group with a higher median overall survival in the LCC group (32 vs 21 months). We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage associated with a median overall survival better in left colon cancer.

Pancreatic injuries following laparoscopic splenic flexure mobilization.

To call awareness to pancreatic injury occurring following laparoscopic splenic flexure mobilization (LSFM) and to discuss the mechanisms which led to such an injury. Retrospective review of patients who underwent LSFM as part of their colectomy procedure and sustained pancreatic injuries at a colorectal surgery referral center during 2014-2021. Of 1022 (0.6%) LSFM performed during the study period, six (0.6%) patients were identified in which clinically significant injuries to the pancreas occurred. Two patients had partial transection of the tail of the pancreas and underwent laparoscopic distal pancreatectomy during the index operation. Three patients developed a post-operative pancreatic fistula after their pancreatic injury went undiagnosed during surgery and required percutaneous drainage, one of whom eventually required a distal pancreatectomy for a persistent pancreatic fistula. Another patient developed a peripancreatic fluid collection which resolved with conservative treatment. Pancreatic injury is rare and a potentially major complication of LSFM. Anatomical misperception, retroperitoneal bleeding, a large bulky splenic flexure tumor, and a "difficult flexure" were recognized as possible mechanisms of such injury.

Subtotal colectomy, extended right hemicolectomy, left hemicolectomy, or splenic flexure colectomy for splenic flexure tumors: a network meta-analysis.

To perform a network meta-analysis of the current literature to evaluate the short-term and long-term outcomes of four operations for splenic flexure tumors. An electronic literature search of PubMed, Baidu Scholar, EMBASE, and Cochrane Central Register of Controlled Trials databases was performed up to August 2020. A Bayesian network meta-analysis was utilized to compare the outcomes involved in subtotal colectomy (STC), extended right hemicolectomy (ERHC), standard left hemicolectomy (LHC), and splenic flexure colectomy (SFC) by using R software. A total of 10 non-randomized studies were included in this meta-analysis. There was no statistically significant difference among these 4 surgical techniques in terms of the utilization rate of minimally invasive surgery, reoperative surgery, anastomotic dehiscence, mortality, the proportion of patients with the number of lymph nodes harvested ≥ 12, local recurrence, distant recurrence and overall survival. Although ERHC was associated with a higher risk of postoperative ileus (ERHC vs SFC, OR = 6.4, 95% CI 1.4-45.0, P = 0.019), it has an advantage of a higher rate of primary anastomosis (ERHC vs LHC, OR = 4.2, 95% CI 1.3-18.0, P = 0.019) and a non-significant trend for lower anastomotic dehiscence when compared with more restrict resections. SFC, LHC, ERHC and STC for the curative resection of splenic flexure tumors provide similar survival. An individualized surgical plan considering both long-term and short-term outcomes is necessary to select the appropriate operations.

Comparison of extended right hemicolectomy, left hemicolectomy and segmental colectomy for splenic flexure colon cancer: a systematic review and meta-analysis.

The aim of this work was to compare the outcomes of extended right hemicolectomy (ERH), left hemicolectomy (LH) and segmental colectomy (SC) for the surgical management of splenic flexure tumours. In compliance with PRISMA statement standards, a systematic review was performed to identify all studies comparing outcomes of ERH, LH and SC for the surgical management of splenic flexure tumours. Primary outcomes included anastomotic leakage and all postoperative complications. The secondary outcomes included operative time, R0 resection, number of harvested lymph nodes, >12 harvested lymph nodes, severe complications, postoperative mortality, paralytic ileus, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, 5-year overall survival and 5-year disease-free survival. The ROBINS-I tool and GRADE system were used to assess the risk of bias and certainty of evidence, respectively. Analysis of 956 patients from seven observational studies showed that ERH was associated with more paralytic ileus than LH (OR 2.74, P=0.002) and SC (OR 6.67, P<0.0001) and the operative time was shorter in SC than in ERH (mean difference 25.48, P<0.0001) and LH (mean difference -17.94, P=0.0002). There were no differences between ERH, LH and SC in terms of anastomotic leakage, postoperative complications, R0 resection, severe complications, postoperative mortality, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, >12 harvested lymph nodes, 5-year overall survival and 5-year disease-free survival. The available evidence, limited to observational studies, suggests that there is no difference between ERH, LH and SC in terms of postoperative morbidity and mortality, lymph node yield and cancer survival. Randomized controlled trials are required for definite conclusions.

Is Segmental Colon Resection an Alternative Treatment for Splenic Flexure Cancer?

Background: Optimal elective surgery for splenic flexure cancer is unclear. Three types of surgical treatment methods are commonly used, subtotal colectomy (STC), left hemicolectomy (LHC), and segmental colon resection (SCR), but consensus is lacking as to which is the optimal method. Materials and Methods: We retrospectively compared clinicopathological and operative results, morbidity, mortality, and long-term survival in patients with splenic flexure cancer who underwent surgery between 1998 and 2018. Results: The study included 124 patients in the study. Following retrospective evaluation of the database, patients were classified into one of three groups according to the surgical approach: (1) STC (n: 41), (2) LHC (n: 55), and (3) SCR (n: 28). No statistically significant differences were found between groups regarding operative results, hospital stay, pathological data, mortality, recurrence, or long-term survival outcomes. Conclusion: Our results suggest that surgical procedures such as STC and LHC have no statistically significant clinical benefits over less aggressive approaches such as SCR. We thus conclude that SCR seems both a safe and effective alternative for splenic flexure tumors.

Fully Robotic Resection of a Splenic Flexure Tumor with Intracorporeal Anastomosis.

Surgical resection of splenic flexure tumors (SFTs) is challenging because of the proximity of the spleen, stomach, and pancreas and the dual blood supply from the superior and inferior mesenteric vessels.1,2 A minimally invasive approach to SFT resection offers the advantage of avoiding a large inc

Colonic Stent Use in Patients With Malignant Flexure Tumors Presenting With Obstruction.

Background and Objective:Colonic stenting in left-sided tumor is being commonly used. However, placing a stent in the flexure tumors is rare because it is technically more difficult. In this study, we aimed to retrospectively screen patients with flexure tumors admitted to our clinic who were treated using a colonic stent and discuss our findings.Methods:Patients admitted to the emergency department for obstructive colonic tumors between 2012 and 2017 were retrospectively evaluated, and 21 patients treated using stents were included in the study. The expandable metal stent (Wallflex®, Boston Scientific, Marlborough, MA, USA) was placed at the obstruction through the lead wire.Results:The mean age of the patients was 62 years, and the ratio of females to males was 3:18. Splenic flexure tumors were detected in 18 patients and hepatic flexure tumors in 3 patients. Seven of the patients were stented for palliative purposes. Fourteen of the cases underwent surgery. Three of them underwent laparoscopic surgery and eleven underwent open surgery.Conclusions:Preoperative stenting in colonic flexura tumors is associated with faster healing, less postoperative complications, lower rates of colostomy, and higher rates of minimally invasive surgery, and can be safely used at experienced centers.

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

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.

Laparoscopic resection of splenic flexure tumors.

In this paper a single institution experience in laparoscopic treatment of splenic flexure tumors (SFT) is reported. Low incidence of these tumors and complexity of the procedure make the laparoscopic resection not diffuse and not well standardized. Since 2004, in a specific database, we prospectively record clinicopathological features and outcome of all patients submitted to laparoscopic colorectal resection. From January 2004 to October 2015, out of 567 cases of minimally invasive colorectal procedures, we performed 20 laparoscopic resection of SFT, 11 with extracorporeal anastomosis and 9 totally laparoscopic. Twelve patients had an advanced disease. Conversion rate was null. The mean operative time was 105' (range 70'-135'). Comparing extracorporeal and intracorporeal anastomoses, we did not find any significant difference in mean duration of surgery. Mean distal margin was 9.4±3.1cm (mean±DS), mean proximal margin 8.9±2.7cm. The mean number of harvested lymph nodes was 17.8±5.6. Evaluating surgical short-term and oncological mid-term outcomes, laparoscopic resection of splenic flexure for tumors, even if challenging, resulted technically feasible and oncologically safe and it seems to be advisable.

Case Report of the Descending Colon Located Completely in the Right Extraperitoneal Cavity and Sigmoid Colon Located in the Right Quadrant in a Patient with a Splenic Flexure Tumor: a Rare Anomaly.

Cases in which congenital anomalies of the colon and colon tumors are observed together are very rare. The aim of this article is to present a splenic flexure tumor case, which possessed the anomaly of the descending colon in the right extraperitoneal space and the sigmoid colon located in the right quadrant. Similar findings have previously been reported in two cases in cadaveric studies.

Duodenojejunal flexure tumors: surgical difficulties with case series.

Distal duodenal and duodenojejunal flexure tumors are rare. They present late due to vague symptomatology and difficulties in establishing a diagnosis. Due to vague symptoms, these tumors would have had spread locally or metastasized to regional nodes or distant organs at presentation. Though the present standard is to achieve R0 resection for any tumor, it is quite difficult in these tumors because of their proximity to many important named vessels and viscera. Role of neoadjuvant and adjuvant therapy is not established yet. Medical records of patients searched who were admitted and diagnosed to have duodenal tumors between January, 2011 and March, 2014. Patients with duodenal tumors arising from third or fourth part were analysed. Radiological, endoscopic findings were noted and compared with operative and histopathological report. Nine patients (seven males and two females) were found to have tumor in the third and fourth part of the duodenum. All had undergone laparotomy with curative intention in eight patients. R0 resection was feasible only in five (55%) patients. The most common histopathological type is adenocarcinoma in 66% patients. Segmental resection is feasible and may be curative in most of the patients with duodenojejunal flexure tumors, without the need for vascular resections and reconstructions. Adenocarcinomas are the most common variant. Lymph node involvement and microvascular invasion indicates poor prognosis.