Subtotal colectomy versus left hemicolectomy for the elective treatment of splenic flexure colonic neoplasia

Beisani, Marc; Vallribera, Francesc; García, Albert; Mora, Laura; Biondo, Sebastiano; Lopez-Borao, Jaime; Farrés, Ramón; Gil, J.; Espín, Eloy

doi:10.1016/j.amjsurg.2017.06.035

Cited by 32 publications

(19 citation statements)

References 27 publications

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“…In our series no unplanned splenectomy was required and 30-day mortality was comparable to other studies without significant differences between ERH and LCR [8,38]. Likewise, Beisani et al [39] found no difference in postoperative mortality comparing subtotal colectomy with left hemicolectomy in an observational study of 144 elective procedures. The former subgroup exhibited a higher morbidity, mainly due to prolonged postoperative ileus.…”

Section: Discussionsupporting

confidence: 80%

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Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short‐term outcomes

et al. 2019

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Aim The optimal surgical treatment of splenic flexure neoplasm is still not well defined. Extended right hemicolectomy (ERH) and left colic resection (LCR) have been proposed but conclusive evidence concerning postoperative morbidity and oncological results is lacking. The aim of this study was to analyse the short-term outcomes after surgery for splenic flexure cancer with regard to surgical procedure and surgeon's specialty.Methods This was a multicentre study on patients who underwent surgery for primary colon cancer of the splenic flexure.Results From 2004 to 2015, 324 patients fulfilled the criteria for inclusion into the study; 270 (83.4%) had elective surgery while 54 (16.6%) had emergency resection: 158 (48.8%) underwent ERH and 166 (51.2%) LCR; 176 (54.3%) procedures were performed by colorectal surgeons, 148 (46.7%) by general surgeons. In the ERH group a significantly higher rate of emergency operations was carried out (P = 0.005). After elective surgery, no significant differences between ERH and LCR concerning 30-day mortality (3.3% vs 2.0%) and the need for reoperation (10.6% vs 7.4%) were found.Nodal harvesting was significantly higher in the ERH and colorectal surgeon groups in any clinical scenario. At multivariate analysis, age and smoking habit were predictive of the need for reoperation and major morbidity while the general surgeon group showed a higher risk of anastomotic failure (OR = 1.92; P = 0.168).Conclusion We analysed the largest series in literature of curative resections for splenic flexure tumours. The optimal procedure still remains debatable as ERH and LCR appear to achieve comparable short-term outcomes. Surgeon's specialty seems to positively affect patient's outcomes.Keywords Colon cancer, splenic flexure, surgery, extended right hemicolectomy, left colon resection, surgeon's specialty What does this paper add to the literature? This is the largest series analysing the surgical treatment of splenic flexure cancer comparing the short-term outcomes of two different surgical techniques performed by two different types of surgeons: general surgeons and colorectal surgeons.

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Section: Discussionsupporting

confidence: 80%

“…Likewise, Beisani et al . found no difference in postoperative mortality comparing subtotal colectomy with left hemicolectomy in an observational study of 144 elective procedures. The former subgroup exhibited a higher morbidity, mainly due to prolonged postoperative ileus.…”

Section: Discussionmentioning

confidence: 95%

Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short‐term outcomes

et al. 2019

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“…Although subtotal colectomy and ERH have never been compared with each other in the literature, a limited number of small observational studies have compared subtotal colectomy and LH for management of splenic flexure tumours. Beisani et al [29] showed that subtotal colectomy was associated with higher surgical morbidity than LH with no difference in long-term oncological outcomes. We did not include this study in our review, as subtotal colectomy is a very different procedure from ERH; in addition to that which is resected in ERH, subtotal colectomy involves resection of the entire descending colon and sigmoid colon and ligation of the inferior mesenteric artery.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Aim 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. Method 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, 5year 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. Results 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 À17.94, 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. Conclusions 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.

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“…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]. In recent years, however, several studies have questioned which type of resection would provide the best surgical and oncological outcomes in patients with SFCs [1,[5][6][7][8][9][10][11][12][13]. 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].…”

Section: Introductionmentioning

confidence: 99%

Emergency surgery for splenic flexure cancer: results of the SFC Study Group database

et al. 2021

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Background The 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. Method This 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. Results The 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. Conclusion In 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.

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Subtotal colectomy versus left hemicolectomy for the elective treatment of splenic flexure colonic neoplasia

Cited by 32 publications

References 27 publications

Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short‐term outcomes

Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short‐term outcomes

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

Emergency surgery for splenic flexure cancer: results of the SFC Study Group database

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