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DOI: 10.1055/s-0041-1740201
A Comparison between Different Management Surgical Approaches in the Treatment of Splenic Flexure Colon Cancer
Abstract
Background There are many surgical approaches which described extent of resection of the colon for adequate surgical management of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of the mesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure.
Objective In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,.
Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy.
Results We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p < 0.001).
Conclusion We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure.
Limitations of the Present Study
Its monocenter nature.
Recommendations
We recommend performing large scale, multicenter, prospective, and randomized studies to prove our data regarding the surgical management of splenic flexure cancer.
Publication History
Received: 20 March 2021
Accepted: 06 August 2021
Article published online:
31 January 2022
© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Rega D, Pace U, Scala D. et al. Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center. Sci Rep 2019; 9 (01) 10953
- 2 Milone M, Angelini P, Berardi G. et al. Intracorporeal versus extracorporeal anastomosis after laparoscopic left colectomy for splenic flexure cancer: results from a multi-institutional audit on 181 consecutive patients. Surg Endosc 2018; 32 (08) 3467-3473
- 3 Shaikh IA, Suttie SA, Urquhart M, Amin AI, Daniel T, Yalamarthi S. Does the outcome of colonic flexure cancers differ from the other colonic sites?. Int J Colorectal Dis 2012; 27 (01) 89-93
- 4 Odermatt M, Siddiqi N, Johns R. et al. Short- and long-term outcomes for patients with splenic flexure tumours treated by left versus extended right colectomy are comparable: a retrospective analysis. Surg Today 2014; 44 (11) 2045-2051
- 5 Chong CS, Huh JW, Oh BY. et al. Operative Method for Transverse Colon Carcinoma: Transverse Colectomy Versus Extended Colectomy. Dis Colon Rectum 2016; 59 (07) 630-639
- 6 van Rongen I, Damhuis RA, van der Hoeven JA, Plaisier PW. Comparison of extended hemicolectomy versus transverse colectomy in patients with cancer of the transverse colon. Acta Chir Belg 2013; 113 (02) 107-111
- 7 UICC TNM classification of malignant tumors. 7th ed.. New York: John Wiley & Sons; 2009
- 8 Feig BW, Ching CD. The MD Anderson Surgical Oncology Handbook, Department of Surgical Oncology. (eds University of Texas MD Anderson Cancer Center). Philadelphia, P. A.: Lippicott Williams & Wilkins; 2011
- 9 Kim JW, Kim JY, Kang BM, Lee BH, Kim BC, Park JH. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study. OncoTargets Ther 2016; 9: 2203-2209
- 10 Sakorafas GH, Zouros E, Peros G. Applied vascular anatomy of the colon and rectum: clinical implications for the surgical oncologist. Surg Oncol 2006; 15 (04) 243-255
- 11 West NP, Kobayashi H, Takahashi K. et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 2012; 30 (15) 1763-1769
- 12 Otchy D, Hyman NH, Simmang C. et al; Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for colon cancer. Dis Colon Rectum 2004; 47 (08) 1269-1284
- 13 Bourgouin S, Bège T, Lalonde N. et al. Three-dimensional determination of variability in colon anatomy: applications for numerical modeling of the intestine. J Surg Res 2012; 178 (01) 172-180
- 14 Griffiths JD. Surgical anatomy of the blood supply of the distal colon. Ann R Coll Surg Engl 1956; 19 (04) 241-256
- 15 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 (03) 204-209
- 16 Vasey CE, Rajaratnam S, O'Grady G, Hulme-Moir M. Lymphatic Drainage of the Splenic Flexure Defined by Intraoperative Scintigraphic Mapping. Dis Colon Rectum 2018; 61 (04) 441-446
- 17 Pisani Ceretti A, Maroni N, Sacchi M. et al. Laparoscopic colonic resection for splenic flexure cancer: our experience. BMC Gastroenterol 2015; 15 (15) 76
- 18 de'Angelis N, Hain E, Disabato M. et al. Laparoscopic extended right colectomy versus laparoscopic left colectomy for carcinoma of the splenic flexure: a matched case-control study. Int J Colorectal Dis 2016; 31 (03) 623-630
- 19 Shen SS, Haupt BX, Ro JY, Zhu J, Bailey HR, Schwartz MR. Number of lymph nodes examined and associated clinicopathologic factors in colorectal carcinoma. Arch Pathol Lab Med 2009; 133 (05) 781-786
- 20 Kim CW, Shin US, Yu CS, Kim JC. Clinicopathologic characteristics, surgical treatment and outcomes for splenic flexure colon cancer. Cancer Res Treat 2010; 42 (02) 69-76
- 21 Dotan E, Cohen SJ. Challenges in the management of stage II colon cancer. Semin Oncol 2011; 38 (04) 511-520
- 22 Weber K, Merkel S, Perrakis A, Hohenberger W. Is there a disadvantage to radical lymph node dissection in colon cancer?. Int J Colorectal Dis 2013; 28 (02) 217-226
- 23 Martínez-Pérez A, Brunetti F, Vitali GC, Abdalla S, Ris F, de'Angelis N. Surgical Treatment of Colon Cancer of the Splenic Flexure: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2017; 27 (05) 318-327
- 24 Gravante G, Elshaer M, Parker R. et al. Extended right hemicolectomy and left hemicolectomy for colorectal cancers between the distal transverse and proximal descending colon. Ann R Coll Surg Engl 2016; 98 (05) 303-307
- 25 Perrakis A, Weber K, Merkel S. et al. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Colorectal Dis 2014; 29 (10) 1223-1229