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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(01): 047-053
DOI: 10.1055/s-0041-1740201
Original Article

A Comparison between Different Management Surgical Approaches in the Treatment of Splenic Flexure Colon Cancer

Elsayed I. El-Hendawy
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Mohamed Farouk Amin
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed M. Fahmy
2   Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed Z. Alattar
3   Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Shereen Elshorbagy
4   Department of Medical Oncology, Zagazig University Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ola A. Harb 
5   Department of Pathology, Zagazig University Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed Fathy Gomaa
6   Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed Embaby
6   Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed M. Elsayed
7   Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Gamal Osman
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ramadan M. Ali
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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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.

Keywords

splenic flexure cancer - surgery - segmental resection - outcome

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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