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Wang X, Wang Y, Zheng Z, Chen Z, Xie Z, Lu X, Huang S, Huang Y, Chi P. 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. Updates Surg 2024:10.1007/s13304-024-01897-1. [PMID: 38822222 DOI: 10.1007/s13304-024-01897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/18/2024] [Indexed: 06/02/2024]
Abstract
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 ≥ 7 cm. 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.
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Affiliation(s)
- Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Yangyang Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zhifang Zheng
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zhiping Chen
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zhongdong Xie
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xingrong Lu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Shenghui Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
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Luo W, Chen P, Du Q, Yang L, Zhou Z. Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer. BMC Surg 2024; 24:128. [PMID: 38678192 PMCID: PMC11055381 DOI: 10.1186/s12893-024-02424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND During laparoscopic left hemicolectomy procedures, a previously overlooked consistently thick blood vessel within the gastrocolic ligament near the splenic hilum may contribute to post-operative bleeding complications. The purpose of this study was to investigate the identification and management of the previously overlooked blood vessel. METHODS This is a retrospective descriptive study of patients undergoing laparoscopic left colectomy for splenic fexure cancer conducted at a national gastrointestinal surgery centre in China. Consecutive patients with splenic fexure cancer who underwent laparoscopic left colectomy using our"five-step process"(n = 34) between January 2021 and July 2023 were included. RESULTS The vessels can be effectively exposed using the aforementioned "five-step process." It was observed that the overlooked vessels consistently present in all patients were identified as the omental branch of the left gastroepiploic artery and vein. CONCLUSION We have identified the origin of previously overlooked blood vessels and recommended a safe method for their management. This may offer advantages to colorectal surgeons performing laparoscopic left colectomy for splenic flexure cancer.
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Affiliation(s)
- Wenjun Luo
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Peng Chen
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qiang Du
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lie Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Zongguang Zhou
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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Cao Y, He M, Chen K, Liu Z, Khlusov DI, Khorobrykh TV, Cao X, Panova PD, Efetov SK, Kazaryan AM. Short- and long-term outcomes after surgical treatment of 5918 patients with splenic flexure colon cancer by extended right colectomy, segmental colectomy and left colectomy: a systematic review and meta-analysis. Front Oncol 2024; 14:1244693. [PMID: 38686198 PMCID: PMC11057231 DOI: 10.3389/fonc.2024.1244693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
Background Colorectal cancer is among the most common cancers in the world, and splenic flexure colon cancer accounts for about 2-5% of them. There is still no consensus on the surgical treatment of splenic flexure colon cancer (SFCC), and the extent of surgical resection and lymph node dissection for SFCC is still controversial. Aim To compare the postoperative and long-term oncologic outcomes of extended right colectomy (ERC), segmental colectomy (SC) and left colectomy (LC) for SFCC. Method Up to March 2024, retrospective and prospective studies of ERC, SC, and LC for SFCC were searched through databases. Pooled weighted/standardized mean difference (WMD/SMD), odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated using a fixed effects model or random effects model, and meta-analysis was performed using Stata. Results This meta-analysis includes 5,918 patients from 13 studies with more lymph node harvest (OR:6.29; 95%Cl: 3.66-8.91; Z=4.69, P=0), more operation time (WMD: 22.53; 95%Cl: 18.75-26.31; Z=11.68, P=0), more blood loss (WMD:58.44; 95%Cl: 20.20-96.68; Z=2.99, P=0.003), longer hospital stay (WMD:1.74; 95%Cl: 0.20-3.29; Z=2.21, P=0.03), longer time to return to regular diet (WMD:3.17; 95%Cl: 2.05-4.30; Z=5.53, P=0), longer first flatus time (WMD:1.66; 95%Cl: 0.96-2.37; Z=4.61, P=0) in ERC versus SC. More lymph node harvest (WMD: 3.52; 95% Cl: 1.59-5.44; Z=3.58, P=0) in ERC versus LC and LC versus SC (WMD: 1.97; 95% CI: 0.53-3.41; Z=2.68, P=0.007), respectively. There is no significant difference between anastomotic leakage, postoperative ileus, total postoperative complication, severe postoperative complication, wound infection, reoperations, R0 resection, postoperative mortality, 5-year overall survival (OS), 5-year disease-free survival (DFS) in three group of patients. In LC versus SC and ERC versus LC, there is no difference between operation time, blood loss, hospital stay, return to regular diet, and first flatus. Conclusion In the included studies, SC and LC may be more advantageous, with fewer postoperative complications and faster recovery. ERC harvests more lymph nodes, but there is no significant difference in long-term OS and DFS between the three surgical approaches. Given that the included studies were retrospective, more randomized controlled trials are needed to validate this conclusion.
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Affiliation(s)
- Yu Cao
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mingze He
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kuo Chen
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zheng Liu
- Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Denis I. Khlusov
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tatyana V. Khorobrykh
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Xinren Cao
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Polina D. Panova
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey K. Efetov
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Airazat M. Kazaryan
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Surgery, Østfold Hospital Trust, Grålum, Norway
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Surgery, Fonna Hospital Trust, Odda, Norway
- Department of Surgery No. 1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia
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Saklani A, Kazi M, Desouza A, Sharma A, Engineer R, Krishnatry R, Gudi S, Ostwal V, Ramaswamy A, Dhanwat A, Bhargava P, Mehta S, Sundaram S, Kale A, Goel M, Patkar S, Vartey G, Kulkarni S, Baheti A, Ankathi S, Haria P, Katdare A, Choudhari A, Ramadwar M, Menon M, Patil P. Tata Memorial Centre Evidence Based Management of Colorectal cancer. Indian J Cancer 2024; 61:S29-S51. [PMID: 38424681 DOI: 10.4103/ijc.ijc_66_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
ABSTRACT This review article examines the evidence-based management of colorectal cancers, focusing on topics characterized by ongoing debates and evolving evidence. To contribute to the scientific discourse, we intentionally exclude subjects with established guidelines, concentrating instead on areas where the current understanding is dynamic. Our analysis encompasses a thorough exploration of critical themes, including the evidence surrounding complete mesocolic excision and D3 lymphadenectomy in colon cancers. Additionally, we delve into the evolving landscape of perioperative chemotherapy in both colon and rectal cancers, considering its nuanced role in the context of contemporary treatment strategies. Advancements in surgical techniques are a pivotal aspect of our discussion, with an emphasis on the utilization of minimally invasive approaches such as laparoscopy and robotic surgery in both colon and rectal cancers, including advanced rectal cases. Moving beyond conventional radical procedures, we scrutinize the feasibility and implications of endoscopic resections for small tumors, explore the paradigm of organ preservation in locally advanced rectal cancers, and assess the utility of total neoadjuvant therapy in the current treatment landscape. Our final segment reviews pivotal trials that have significantly influenced the management of colorectal liver and peritoneal metastasis.
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Affiliation(s)
- Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Advanced Centre of the Treatment, Research, and Education in Cancer, Kharghar, Navi Mumbai, India
| | - Ashwin Desouza
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Ankit Sharma
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Advanced Centre of the Treatment, Research, and Education in Cancer, Kharghar, Navi Mumbai, India
| | - Reena Engineer
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rahul Krishnatry
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shivkumar Gudi
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vikas Ostwal
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anant Ramaswamy
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Aditya Dhanwat
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Prabhat Bhargava
- Homi Bhabha National Institute, Mumbai, India
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shaesta Mehta
- Homi Bhabha National Institute, Mumbai, India
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Sridhar Sundaram
- Homi Bhabha National Institute, Mumbai, India
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Aditya Kale
- Homi Bhabha National Institute, Mumbai, India
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Gurudutt Vartey
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Suyash Kulkarni
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Akshay Baheti
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Suman Ankathi
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Purvi Haria
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Aparna Katdare
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Amit Choudhari
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Mukta Ramadwar
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Munita Menon
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Prachi Patil
- Homi Bhabha National Institute, Mumbai, India
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
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Lennon D, Donnelly M, Mahon J, Ryan ÉJ, Ryan OK, Davey MG, Hanly A, Kennelly R, Winter DC, Martin S. Surgical management strategies for colorectal malignancies of the splenic flexure - A systematic review and network meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107087. [PMID: 37793302 DOI: 10.1016/j.ejso.2023.107087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/27/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Extended right hemicolectomy (ERHC) or left hemicolectomy (LHC) are accepted as the standard-of-care for colonic tumours of the splenic flexure. Lymphatic drainage at this site is poorly defined and subject to significant heterogeneity. Nevertheless, emerging evidence demonstrates the potential oncological safety of segmental splenic flexure colectomy (SFC). AIM To perform a systematic review and network meta-analysis (NMA) to compare outcomes following ERHC, LHC and SFC for splenic flexure tumours (SFTs). METHODS A systematic review was performed as per PRISMA guidelines. NMA was performed using R Shiny and Netmeta packages. RESULTS A total of 13 studies, involving 6176 patients (ERHC n = 785; LHC n = 1527; SFC n = 3864) were included in the NMA. There was no difference in overall survival (OS) (SFC vs LHC Hazard Ratio [HR] 1.0, 95% Credible Interval [CrI] 0.76,1.34; SFC vs ERHC HR 1.18, 95% CrI 0.85,1.58) between the groups. SFC had a shorter operation time (Mean 176.37 min; Mean Difference [MD] SFC vs LHC 20.34 min 95% CrI 10.9, 29.97; SFC vs ERHC MD 22.19 95% CrI 11.09, 33.29) but also had a lower average lymph node yield (LNY) compared with ERHC (MD 7.15, 95% CrI 5.71, 8.60). ERHC had a significantly higher incidence of post-operative ileus (Odds Ratio [OR] 3.47, 95% CrI 1.11, 10.84). There was also no difference observed for minimally invasive approaches, anastomotic leak rate, perioperative mortality, reoperation rates or length of stay. CONCLUSIONS While SFC may allow for reduced operative duration and improved bowel function postoperatively. SFC, LHC, ERHC are all acceptable approaches for curative resection of cancers of the splenic flexure, with no difference in OS observed. Thus, surgeon preference and candidate-specific factors will likely determine the management of SFTs.
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Affiliation(s)
- David Lennon
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Mark Donnelly
- Royal College of Surgeons Ireland, St Stephens Green, Dublin 2, Ireland
| | - John Mahon
- Royal College of Surgeons Ireland, St Stephens Green, Dublin 2, Ireland
| | - Éanna J Ryan
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Odhrán K Ryan
- Royal College of Surgeons Ireland, St Stephens Green, Dublin 2, Ireland
| | - Matthew G Davey
- Royal College of Surgeons Ireland, St Stephens Green, Dublin 2, Ireland
| | - Ann Hanly
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Rory Kennelly
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Des C Winter
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Sean Martin
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Tsukamoto S, Ouchi A, Komori K, Shiozawa M, Yasui M, Ohue M, Nogami H, Takii Y, Moritani K, Kanemitsu Y. A multicenter prospective observational study of lymph node metastasis patterns and short-term outcomes of extended lymphadenectomy in right-sided colon cancer. Ann Gastroenterol Surg 2023; 7:940-948. [PMID: 37927926 PMCID: PMC10623977 DOI: 10.1002/ags3.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/17/2023] [Accepted: 05/13/2023] [Indexed: 11/07/2023] Open
Abstract
Background The lymph node metastasis rate in right-sided colon cancer is unknown, and the optimal central vascular ligation level remains controversial. We aimed to determine the lymph node metastasis rate and short-term results of radical surgery with extended lymph node dissection in right-sided colon cancer. Methods This prospective multicenter observational study included patients with stage II/III right-sided colon cancer from five cancer hospitals. The metastasis rate of each node station was analyzed according to tumor location and main feeding artery. Results Between April 2018 and August 2021, 208 patients underwent dissection around the superior mesenteric artery (SMA) and vein (SMV). In transverse colon cancer, 7.5% and 2.5% of metastases occurred around the SMV and SMA at the root of the middle colic artery (MCA), respectively; 6.7% and 6.7% at the root of the right colic artery. In caecal cancer, 1.9% of metastases occurred around the SMV and 1.9% around the SMA. In ascending colon cancer, the rate was 1.1% around the SMV. Of the tumors, 17% fed mainly by the ileocolic artery had node metastases along the middle or right colic artery, as did 66.7% fed mainly by the right colic artery and 41.2% fed by the MCA (p = 0.01). Postoperative complications occurred in 42 patients (20.2%). Conclusion Routine prophylactic extended lymphadenectomy around the SMA might not be necessary in caecum and ascending colon cancer. Dissection around the SMA may be necessary in cases of transverse colon cancer or when the feeding artery is the MCA.
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Affiliation(s)
- Shunsuke Tsukamoto
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Akira Ouchi
- Department of Gastroenterological SurgeryAichi Cancer Center HospitalAichiJapan
| | - Koji Komori
- Department of Gastroenterological SurgeryAichi Cancer Center HospitalAichiJapan
| | - Manabu Shiozawa
- Department of Gastroenterological SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Masayoshi Yasui
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masayuki Ohue
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hitoshi Nogami
- Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Yasumasa Takii
- Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Konosuke Moritani
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
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Freund MR, Horesh N, Emile SH, Garoufalia Z, Gefen R, Wexner SD. Segmental and extended resections provide comparable survival for clinically node-negative splenic flexure cancer: a propensity score-matched analysis of the National Cancer Database. Tech Coloproctol 2023; 27:1073-1081. [PMID: 37071308 DOI: 10.1007/s10151-023-02796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS In total 3498/668,852 (0.5%) patients with clinical stage I-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 91 months; p = 0.94). When survival was stratified by clinical N stage, 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 6 days; p = 0.027). There were no significant differences between the groups in terms of 30-day readmission or 30- or 90-day mortality. CONCLUSIONS 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.
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Affiliation(s)
- Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of Surgery and transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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8
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Belhadjamor R, Manceau G, Menahem B, Sabbagh C, Alves A. Revisited Surgical Anatomy of the Left Colonic Angle for Tailored Carcinologic Colectomy: A Review. J Pers Med 2023; 13:1198. [PMID: 37623449 PMCID: PMC10455574 DOI: 10.3390/jpm13081198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Although several types of surgical procedure have been advocated to date, the optimal resection of the left colonic angle in cancer treatment remains controversial. Located at the border of the transverse and descending colons, the anatomy of the left colonic angle is complex and characterized by numerous anatomic variations. Recent advances in preoperative (three-dimensional CT angiography with colonography) and/or intraoperative (indocyanine green staining) imaging have allowed for a better identification of these variations. METHODS We performed a methodological review of studies assessing the anatomical variations of the left colic artery. RESULTS While the left colonic angle is classically vascularized by branches of the superior and inferior mesenteric arteries, an accessory middle colonic artery has been identified from 6 % to 36% of cases, respectively, leading to their classification of five types. In the absence of a left colic artery, this artery becomes predominant. In parallel to the variations in the venous drainage of the left colonic angle, which has been classified into four types, new lymphatic drainage routes have also been identified via this accessory artery and the inferior mesenteric vein. CONCLUSIONS Collectively, these newly obtained findings plead for preoperative identification in cases of cancer of the left colonic angle and a surgical strategy adapted to these anatomical variations.
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Affiliation(s)
- Roukaya Belhadjamor
- Department of Digestive Surgery, University Hospital of Caen, CS 30001, CEDEX 9, 14033 Caen, France;
| | - Gilles Manceau
- Department of Digestive and Oncology Surgery, Assistance Publique Hôpitaux de Paris, Georges-Pompidou European Hospital, 75908 Paris, France;
| | - Benjamin Menahem
- Calvados Digestive Cancer Registry “ANTICIPE” U1086 INSERM, Team Ligue Contre le Cancer, Centre François Baclesse, University of Caen Normandy, 14000 Caen, France;
- Pôle de Formation et de Recherche en Santé, 2 rue des Rochambelles, 14032 Caen, France
| | - Charles Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, CHU Amiens Picardie, Rond point du Pr Cabrol, 80054 Amiens, France;
- UR7518SSPC (Simplification des Soins des Patients. Chirurgicaux Complexes), Université Picardie Jules Verne, 80000 Amiens, France
| | - Arnaud Alves
- Calvados Digestive Cancer Registry “ANTICIPE” U1086 INSERM, Team Ligue Contre le Cancer, Centre François Baclesse, University of Caen Normandy, 14000 Caen, France;
- Pôle de Formation et de Recherche en Santé, 2 rue des Rochambelles, 14032 Caen, France
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9
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Naidu K, Chapuis PH, Brown KGM, Chan C, Rickard MJFX, Ng KS. Splenic flexure cancer survival: a 25-year experience and implications for complete mesocolic excision (CME) and central vascular ligation (CVL). ANZ J Surg 2023; 93:1861-1869. [PMID: 36978261 DOI: 10.1111/ans.18434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The management of splenic flexure cancers (SFCs) in the era of complete mesocolic excision (CME) and central vascular ligation (CVL) is challenging because of its variable lymphatic drainage. This study aimed to compare survival outcomes for SFCs and non-SFCs, and better understand the clinicopathological characteristics which may define a distinct SFC phenotype. METHODS An observational cohort study at Concord Hospital, Sydney was conducted with patients who underwent resection for colon adenocarcinoma (1995-2019). Clinicopathological data were extracted from a prospective database. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan-Meier and Cox regression analyses. RESULTS Of 2149 patients with colon cancer, 129 (6%) had an SFC. The overall 5-year OS and DFS rates were 63.6% (95% CI 62.5-64.7) and 59.4% (95% CI 58.3-60.5), respectively. SFCs were not associated with OS (P = 0.6) or DFS (P = 0.5). SFCs were more likely to present urgently (P < 0.001) with obstruction (P < 0.001) or perforation (P = 0.03), and more likely to require an open operation (P < 0.001). These characteristics were associated with poorer survival outcomes. No differences were noted between SFCs and non-SFCs with respect to tumour stage (P = 0.3). CONCLUSION SFCs have a distinct phenotype, the individual characteristics of which are associated with poorer survival. However, the survivals of SFCs and non-SFCs are similar, possibly because the most important determinant of outcome, tumour stage, is no different between the groups. This may have implications for the surgical approach to SFCs with respect to standardization of CME and CVL surgery for these cancers.
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Affiliation(s)
- Krishanth Naidu
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
| | - Pierre H Chapuis
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
| | - Kilian G M Brown
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
| | - Charles Chan
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
- Department of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, 2139, Australia
| | - Matthew J F X Rickard
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
| | - Kheng-Seong Ng
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
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10
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Thungathurthi K, Antoniou E, Arachchi A, Tay Y, Nguyen TC, Lim J, Chouhan H, Narasimhan V, Teoh W. Surgical management of splenic flexure cancer: is there an optimal technique? A bi-national registry analysis. ANZ J Surg 2023; 93:1854-1860. [PMID: 37158233 DOI: 10.1111/ans.18469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION Segmental and extended resections are both oncologically sound procedures for SFCs. Segmental resections are associated with lower rates of prolonged ileus.
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Affiliation(s)
| | - Ellathios Antoniou
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Asiri Arachchi
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Yeng Tay
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - T C Nguyen
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - James Lim
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Hanumant Chouhan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
| | - William Teoh
- Department of Colorectal Surgery, Monash Health, Melbourne, Victoria, Australia
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11
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Cheng H, Zhou M, Yang L, Sui Z. The impact of laparoscopic, open, extended right, and left colectomy on clinical outcomes of splenic flexure colon cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33742. [PMID: 37171307 PMCID: PMC10174352 DOI: 10.1097/md.0000000000033742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Surgical intervention is the recommended line for the management of colon cancer. The aim of this study was to evaluate the impact of different surgical techniques (laparoscopic, open, extended right, and left colectomy) on clinical outcomes such as mortality, postoperative complications, operation and hospitalization time, and oncological factors. METHODS A total of 15 studies have been included in the current study. The outcomes of these studies were analyzed using a random-effect model and it was used to calculate the mean difference with 95% confidence intervals to quantify the impact of open, laparoscopic, extended right, and left colectomy. Inclusion criteria included studies in which subjects undergo splenic flexure colon cancer surgery with 2 comparable different surgical techniques. RESULTS Laparoscopic splenic flexure colon cancer surgery showed a significant beneficial impact on the length of hospital stay (P < .001), the volume of blood loss during surgery (P < .001), postoperative complications (P < .001), and time to an oral diet (P < .001). On the other hand, there was no significance regarding anastomotic leakage, infection of the surgical site, and operation time. Regarding the comparison between extended right colectomy (ERC) and lift colectomy (LC), analysis findings showed a significant (P = .001) higher efficacy of ERC in harvested number of lymph nodes compared with LC. On the other hand, there was no significant difference for the rest of the parameters. The neoadjuvant therapy as an influencing factor on postoperative outcome showed a beneficial impact regarding the overall survival rate. CONCLUSION Laparoscopic splenic flexure colon cancer surgery showed a significant beneficial impact compared with open surgery as proved by clinical outcomes. On the other hand, ERC and LC resulted in similar findings except for harvested lymph nodes, results were in favor of ERC.
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Affiliation(s)
- Hefei Cheng
- Department of Gastroenterology, The First People's Hospital of Lin Ping District, Hangzhou, Zhejiang, P. R. China
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12
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Rusli SM, Choo JM, Lee TH, Piozzi GN, Cuellar-Gomez H, Baek SJ, Kwak JM, Kim J, Kim SH. Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival. Colorectal Dis 2023; 25:431-442. [PMID: 36281503 DOI: 10.1111/codi.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/04/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023]
Abstract
AIM The applicability of laparoscopic D3 oncological resection for splenic flexure cancer (SFC) surgery has not been fully explored due to technical difficulties and variations in surgical procedure. The aim of this work is to describe the feasibility of performing laparoscopic D3 resection in SFC and its impact on long-term survival. METHOD A retrospective study on 47 out of 52 consecutive patients who underwent elective laparoscopic colectomy for SFC from December 2006 until December 2019 at Korea University Anam Hospital was performed. Data on patients' demographic and clinical features, surgical procedures, intraoperative and postoperative complications, pathological features and follow-up were collected. Categorical data are expressed as frequencies (n) and percentages (%). Continuous data are expressed as mean ± standard deviation and median (range). The Kaplan-Meier test was used to determine the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). RESULTS The median age of patients was 67.0 years (range 27-87 years) and 72.3% were men. Ten (21.3%) patients presented with an obstructing tumour and underwent an elective laparoscopic colectomy, while 68.1% of patients presented with Stage II and III disease. The conversion rate was 4.3% and the morbidity rate was 31.9%. There was one postoperative death secondary to splenic infarction and anastomotic leak leading to multi-organ failure. Four deaths occurred due to disease progression during a median follow-up of 63.8 months. The rate of recurrence was 20%, the 5-year OS was 89.6% and the 5-year PFS was 72.9%. After R0 resection, the 5-year OS was 91.5% and the 5-year DFS was 74.5%. CONCLUSION Laparoscopic D3 colectomy for SFC is feasible, with an acceptable morbidity and long-term oncological outcome when performed by highly skilled laparoscopic colorectal surgeons with knowledge of the complex anatomy around the splenic flexure. Further randomized trials should be performed to determine the advantage of laparoscopic D3 colectomy over conventional colectomy for SFC.
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Affiliation(s)
- Siti Mayuha Rusli
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
- Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Jeong Min Choo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Tae Hoon Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Guglielmo Niccolò Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hugo Cuellar-Gomez
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Se Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jung Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seon Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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13
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D’Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023; 37:977-988. [PMID: 36085382 PMCID: PMC9944710 DOI: 10.1007/s00464-022-09547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.
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Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy. .,Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- grid.7605.40000 0001 2336 6580BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.432329.d0000 0004 1789 4477Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- grid.417728.f0000 0004 1756 8807Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Francesca Pecchini
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Roberta La Mendola
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’Umanesimo, 10, 00144 Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Francesco Marchegiani
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- grid.18887.3e0000000417581884Gastrointestinal Surgery, San Raffaele Hospital, 20132 Milan, Italy
| | - Luca Ferraro
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- grid.9024.f0000 0004 1757 4641UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D’Ugo
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy ,grid.415928.3Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Alessandro Ferrero
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’umanesimo, 10, 00144 Rome, Italy
| | - Angelo Restivo
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Micaela Piccoli
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Antonino Spinelli
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56 Rozzano, 20089 Milan, Italy ,grid.452490.eDepartment of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.419555.90000 0004 1759 7675Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060 Torino, Italy
| | - Marco Guerrieri
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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14
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Watanabe J, Kanemitsu Y, Suwa H, Kakeji Y, Ishihara S, Shinto E, Ozawa H, Suto T, Kawamura J, Fujita F, Itabashi M, Ohue M, Ike H, Sugihara K. A multicenter cohort study on mapping of lymph node metastasis for splenic flexural colon cancer. Ann Gastroenterol Surg 2022; 7:265-271. [PMID: 36998296 PMCID: PMC10043763 DOI: 10.1002/ags3.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 04/01/2023] Open
Abstract
Aim There have been no reports of searching for metastases to lymph nodes along the accessory middle colic artery (aMCA). The aim of this study was to investigate the metastasis rate of the aMCA for splenic flexural colon cancer. Methods Patients with histologically proven colon carcinoma located in the splenic flexure, clinically diagnosed as stage I-III were eligible for this study. Patients were retrospectively and prospectively enrolled. The primary endpoint was frequency of lymph node metastasis to the aMCA (station 222-acc and 223-acc). The secondary endpoint was the frequency of lymph node metastasis to the middle colic artery (MCA) (station 222-lt and 223) and left colic artery (LCA) (station 232 and 253). Results Between January 2013 and February 2021, a total of 153 consecutive patients were enrolled. The location of the tumor was 58% in the transverse colon and 42% in the descending colon. Lymph node metastases were observed in 49 cases (32%). The presence of aMCA rate was 41.8% (64 cases). The metastasis rates of stations 221, 222-lt, and 223 were 20.0%, 1.6%, and 0%, and stations 231, 232, and 253 were 21.4%, 1.0%, and 0%, respectively. The metastasis rates of stations 222-acc and 223-acc were 6.3% (95% confidence interval: 1.7%-15.2%) and 3.7% (95% confidence interval: 0.1%-19%), respectively. Conclusions This study identified the distribution of lymph node metastases from splenic flexural colon cancer. If the aMCA is present, this vessel should be targeted for dissection, taking into account the frequency of lymph node metastasis.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Gastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Hirokazu Suwa
- Department of SurgeryYokosuka Kyosai HospitalYokosukaJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Eiji Shinto
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Heita Ozawa
- Department of Colorectal SurgeryTochigi Cancer CenterUtsunomiyaJapan
| | - Takeshi Suto
- Department of Gastroenterological SurgeryYamagata Prefectual Central HospitalYamagataJapan
| | - Junichiro Kawamura
- Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan
| | | | - Michio Itabashi
- Department of SurgeryInstitute of Gastroenterology, Tokyo Women's Medical UniversityTokyoJapan
| | - Masayuki Ohue
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hideyuki Ike
- Department of SurgeryJCHO Yokohama Hodogaya Central HospitalYokohamaJapan
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15
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Suh JW, Park J, Lee J, Yang IJ, Ahn HM, Oh HK, Kim DW, Kang SB. Clinical impact of inferior mesenteric vein preservation during left hemicolectomy with low ligation of the inferior mesenteric artery for distal transverse and descending colon cancers: A comparative study based on computed tomography. Front Oncol 2022; 12:986516. [PMID: 36081545 PMCID: PMC9445569 DOI: 10.3389/fonc.2022.986516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Presence of a long remnant sigmoid colon after left hemicolectomy with inferior mesenteric vein (IMV) ligation for distal transverse and descending colon cancers may be a risk factor for venous ischemia. This study aimed to evaluate the clinical impact of IMV preservation in patients who underwent left hemicolectomy with inferior mesenteric artery (IMA) preservation. Methods We included 155 patients who underwent left hemicolectomy with IMA preservation for distal transverse and descending colon cancers from 2003 to 2020. Technical success of IMV preservation was determined by assessing pre- and post-operative patency of the IMV on computed tomography (CT) by an abdominal radiologist. Intestinal complications comprising ulceration, stricture, venous engorgement, and colitis in remnant colon were compared between the IMV preservation and ligation groups. Results IMV was preserved in 22 (14.2%) and ligated in 133 (85.8%) patients. Surgical time, postoperative recovery outcomes, and number of harvested lymph nodes were similar in both groups. The technical success of IMV preservation was 81.8%. Intestinal complications were less common in the preservation group than in the IMV ligation group (4.5% vs. 23.3%, P=0.048). The complications in the IMV ligation group were anastomotic ulcer (n=2), anastomotic stricture (n=4), venous engorgement of the remnant distal colon (n=4), and colitis in the distal colon (n=21). Conclusions IMV preservation may be beneficial after left hemicolectomy with IMA preservation for distal transverse and descending colon cancers. We suggest that IMV preservation might be considered when long remnant sigmoid colon is expected during left hemicolectomy with low ligation of IMA.
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Affiliation(s)
- Jung Wook Suh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jihoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeehye Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In Jun Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong-Min Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- *Correspondence: Sung-Bum Kang,
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16
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Huang M, Wang X, Shao Y, Huang S, Huang Y, Chi P. Surgical Treatment of SplenicFlexure Colon Cancer: Analysisof Short-Term and Long-Term Outcomes of Three DifferentSurgical Procedures. Front Oncol 2022; 12:884484. [PMID: 35814379 PMCID: PMC9263504 DOI: 10.3389/fonc.2022.884484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to compare the short- and long-term outcomes of splenic flexure colectomy (SFC), left hemicolectomy (LHC) and extended left hemicolectomy (ELHC) for splenic flexure colon cancer. Methods Between January 2011 and December 2018, 117 patients with splenic flexure cancer were enrolled in the study. We retrospectively compared the postoperative, pathological and long-term outcomes of patients with splenic flexure cancer. Results Of the 117 patients, 73 (62.4%) underwent SFC, 22 (18.8%) underwent LHC, and 22 (18.8%) underwent ELHC. No statistically significant differences were found among the groups regarding postoperative complications, pathological data or recurrence. No metastatic lymph nodes at the root of the inferior mesenteric artery (IMA) were observed; lymph node metastasis appeared at the root of the middle colic artery (MCA), but in a low proportion of cases (4.4%). Looking at long-term prognosis, no differences were observed among the three groups regarding both 5-year overall survival (94.0% vs 90.2% vs 94.1%) and disease-free survival (88.2% vs 90.2% vs 83.0%). Conclusion Our retrospective review suggests that splenic flexure colectomy in minimally invasive surgery is a safe and effective treatment option for splenic flexure colon cancer. The rate of metastatic lymph nodes at the root of the central artery and gastroepiploic arcade node was relatively low.
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Affiliation(s)
- Mingjin Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital,
Fuzhou, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital,
Fuzhou, China
| | - Yu Shao
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shenghui Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital,
Fuzhou, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital,
Fuzhou, China
- *Correspondence: Pan Chi, ; Ying Huang,
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital,
Fuzhou, China
- *Correspondence: Pan Chi, ; Ying Huang,
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17
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Pedrazzani C, Turri G, Park SY, Hida K, Fukui Y, Crippa J, Ferrari G, Origi M, Spolverato G, Zuin M, Bae SU, Baek SK, Costanzi A, Maggioni D, Son GM, Scala A, Rockall T, Larson DW, Guglielmi A, Choi GS. Laparoscopic versus open surgery for left flexure colon cancer: A propensity score matched analysis from an international cohort. Colorectal Dis 2022; 24:177-187. [PMID: 34706130 PMCID: PMC9299165 DOI: 10.1111/codi.15962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/20/2021] [Accepted: 10/22/2021] [Indexed: 12/20/2022]
Abstract
AIM Surgical treatment of splenic flexure cancer (SFC) still presents some debated issues, including the role of laparoscopic surgery. The literature is based on small single-centre series, while randomized controlled studies comparing open and laparoscopic treatment for colon cancer exclude SFC. This study aimed to determine the role of laparoscopic surgery in the treatment of SFC, comparing short- and long-term outcomes with open surgery. METHOD This was an international multicentre retrospective cohort study that analysed patients from 10 tertiary referral centres. From a cohort of 641 cases, 484 patients with Stage I-III SFC submitted to elective surgery with curative intent were selected. After 1:1 propensity score matching, 130 patients in the laparoscopic group (LapGroup) were compared with 130 patients in the open surgery group (OpenGroup). RESULTS After propensity score matching, the two groups were comparable for demographic and clinical parameters. OpenGroup presented a higher incidence of overall (P = 0.02) and surgery-related complications (P = 0.05) but a similar rate of severe complications (P = 0.75). Length of stay was notably shorter in the LapGroup (P = 0.001). Overall (P = 0.793) as well as cancer-specific survival (P = 0.63) did not differ between the two groups. CONCLUSIONS Elective laparoscopic surgery for Stage I-III SFC is feasible and associated with improved short-term postoperative outcomes compared to open surgery. Moreover, laparoscopic surgery appears to provide excellent long-term cancer outcomes.
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Affiliation(s)
- Corrado Pedrazzani
- Division of General and Hepatobiliary SurgeryDepartment of Surgical SciencesDentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Giulia Turri
- Division of General and Hepatobiliary SurgeryDepartment of Surgical SciencesDentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Soo Yeun Park
- Colorectal Cancer CentreKyungpook National University Medical CentreSchool of MedicineKyungpook National UniversityDaeguKorea
| | - Koya Hida
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Yudai Fukui
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Jacopo Crippa
- Division of Colon and Rectal SurgeryDepartment of SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Giovanni Ferrari
- Department of General SurgeryNiguarda HospitalASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Matteo Origi
- Department of General SurgeryNiguarda HospitalASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Gaya Spolverato
- First Surgical Clinic SectionDepartment of Surgery, Oncology, and GastroenterologyUniversity of PadovaPadovaItaly
| | - Matteo Zuin
- First Surgical Clinic SectionDepartment of Surgery, Oncology, and GastroenterologyUniversity of PadovaPadovaItaly
| | - Sung Uk Bae
- Division of Colorectal SurgeryDepartment of SurgerySchool of MedicineKeimyung University and Dongsan Medical CentreDaeguKorea
| | - Seong Kyu Baek
- Division of Colorectal SurgeryDepartment of SurgerySchool of MedicineKeimyung University and Dongsan Medical CentreDaeguKorea
| | | | | | - Gyung Mo Son
- Department of SurgeryPusan National University Yangsan HospitalSchool of MedicinePusan National UniversityYangsanKorea
| | - Andrea Scala
- Department of Colorectal and Minimal Access SurgeryRoyal Surrey NHS Foundation TrustGuildfordUK
| | - Timothy Rockall
- Department of Colorectal and Minimal Access SurgeryRoyal Surrey NHS Foundation TrustGuildfordUK
| | - David W. Larson
- Division of Colon and Rectal SurgeryDepartment of SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary SurgeryDepartment of Surgical SciencesDentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Gyu Seog Choi
- Colorectal Cancer CentreKyungpook National University Medical CentreSchool of MedicineKyungpook National UniversityDaeguKorea
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18
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Manceau G, Alves A, Meillat H, Benhaïm L, Ouaïssi M, Panis YH, Tuech JJ, Dousset B, Brigand C, Cotte E, Lakkis Z, Badic B, Marchal F, Sabbagh C, Diouf M, Karoui M. What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis. Dis Colon Rectum 2022; 65:55-65. [PMID: 34882628 DOI: 10.1097/dcr.0000000000001937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The optimal elective colectomy in patients with splenic flexure tumor is debated. OBJECTIVE This study aimed to compare splenic flexure colectomy, left hemicolectomy, and subtotal colectomy for perioperative, histological, and survival outcomes in this setting. DESIGN This is a multicenter retrospective cohort study. SETTING Patients diagnosed with nonmetastatic splenic flexure tumor who underwent elective colectomy were included. PATIENTS Between 2006 and 2014, 313 consecutive patients were operated on in 15 French Research Group of Rectal Cancer Surgery centers. INTERVENTIONS Propensity score weighting was performed to compare short- and long-term outcomes. MAIN OUTCOME MEASURES The primary end point was disease-free survival. Secondary end points included overall survival, quality of surgical resection, overall postoperative morbidity, surgical postoperative morbidity, and rate of anastomotic leakage. RESULTS The most performed surgery was splenic flexure colectomy (59%), followed by subtotal colectomy (23%) and left hemicolectomy (18%). Subtotal colectomy was more often performed by laparotomy compared with splenic flexure colectomy and left hemicolectomy (93% vs 61% vs 56%, p < 0.0001), and was associated with a longer operative time (260 minutes (120-460) vs 180 minutes (68-440) vs 217 minutes (149-480), p < 0.0001). Postoperative morbidity was similar between the 3 groups, but the median length of hospital stay was significantly longer after subtotal colectomy (13 days (5-56) vs 10 (4-175) vs 9 (4-55), p = 0.0007). The median number of harvested lymph nodes was significantly higher after subtotal colectomy compared with splenic flexure colectomy and left hemicolectomy (24 (8-90) vs 15 (1-81) vs 16 (3-52), p < 0.0001). The rate of stage III disease and the number of patients treated by adjuvant chemotherapy were similar between the 3 groups. There was no difference in terms of disease-free survival and overall survival between the 3 procedures. LIMITATIONS The study was limited by its retrospective design. CONCLUSIONS In the elective setting, splenic flexure colectomy is safe and oncologically adequate for patients with nonmetastatic splenic flexure tumor. However, given the oncological clearance after splenic flexure colectomy, it seems that the debate is not completely closed. See Video Abstract at http://links.lww.com/DCR/B703. CUL ES LA COLECTOMA ELECTIVA PTIMA PARA EL CNCER DE NGULO ESPLNICO FIN DEL DEBATE UN ESTUDIO MULTICNTRICO DEL GRUPO GRECCAR CON UN ANLISIS DE PUNTAJE DE PROPENSIN ANTECEDENTES:La colectomía electiva óptima en pacientes con tumores del ángulo esplénico continua en debate.OBJETIVO:Comparar la colectomía de ángulo esplénico, hemicolectomía izquierda y colectomía subtotal para los resultados perioperatorios, histológicos y de supervivencia en este escenario.DISEÑO:Estudio de cohorte retrospectivo multicéntrico.ESCENARIO:Se incluyeron pacientes diagnosticados de tumores del ángulo esplénico no metastásicos que se sometieron a colectomía electiva.PACIENTES:Entre 2006 y 2014, 313 pacientes consecutivos fueron intervenidos en 15 centros GRECCAR.INTERVENCIONES:Se realizó una ponderación del puntaje de propensión para comparar los resultados a corto y largo plazo.PRINCIPALES MEDIDAS DE RESULTADO:El criterio de valoración principal fue la supervivencia libre de enfermedad. Los criterios de valoración secundarios incluyeron la supervivencia general, la calidad de la resección quirúrgica, la morbilidad posoperatoria general, la morbilidad posoperatoria quirúrgica y la tasa de fuga anastomótica.RESULTADOS:La cirugía más realizada fue la colectomía del ángulo esplénico (59%), seguida de la colectomía subtotal (23%) y la hemicolectomía izquierda (18%). La colectomía subtotal se realizó con mayor frecuencia mediante laparotomía en comparación con la colectomía de ángulo esplénico y la hemicolectomía izquierda (93% frente a 61% frente a 56%, p <0.0001), y se asoció con un tiempo quirúrgico más prolongado (260 min [120-460] frente a 180 min [68-440] frente a 217 min [149-480], p <0.0001). La morbilidad posoperatoria fue similar entre los tres grupos, pero la duración media de la estancia hospitalaria fue significativamente más prolongada después de la colectomía subtotal (13 días [5-56] frente a 10 [4-175] frente a 9 [4-55], p = 0.0007). La mediana del número de ganglios linfáticos extraídos fue significativamente mayor después de la colectomía subtotal en comparación con la colectomía del ángulo esplénico y la hemicolectomía izquierda (24 [8-90] frente a 15 [1-81] frente a 16 [3-52], p <0.0001). La tasa de enfermedad en estadio III y el número de pacientes tratados con quimioterapia adyuvante fueron similares entre los 3 grupos. No hubo diferencias en términos de supervivencia libre de enfermedad y supervivencia general entre los 3 procedimientos.LIMITACIONES:El estudio estuvo limitado por su diseño retrospectivo.CONCLUSIONES:En un escenario electivo, la colectomía del ángulo esplénico es segura y oncológicamente adecuada para pacientes con tumores del ángulo esplénico no metastásicos. Sin embargo, dado el aclaramiento oncológico tras la colectomía del ángulo esplénico, parece que el debate no está completamente cerrado. Consulte Video Resumen en http://links.lww.com/DCR/B703.
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Affiliation(s)
- Gilles Manceau
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Digestive and Oncologic Surgery, Paris, France
| | - Arnaud Alves
- University Hospital of Caen, Department of Digestive Surgery, Caen, France
| | - Hélène Meillat
- Institut Paoli Calmettes, Department of Digestive Surgical Oncology, Marseille, France
| | - Léonor Benhaïm
- Gustave Roussy Cancer Campus, Department of Surgical Oncology, Villejuif, France
| | - Mehdi Ouaïssi
- Trousseau Hospital, Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Chambray Les Tours, France
| | - Yves H Panis
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Beaujon Hospital, Department of Colorectal Surgery, Clichy, France
| | - Jean-Jacques Tuech
- Charles Nicolle Hospital, Rouen University, Department of Digestive and General Surgery, Rouen, France
| | - Bertrand Dousset
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, Department of Digestive, Hepato-Biliary and Endocrine Surgery, Paris, France
| | - Cécile Brigand
- Strasbourg University Hospital, Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg, France
| | - Eddy Cotte
- Lyon University Hospital, Center for Digestive and Endocrine Surgery, Lyon Sud Hospital, Lyon, France
| | - Zaher Lakkis
- University Hospital of Besançon, Department of Digestive Surgery, Besançon, France
| | - Bogdan Badic
- La Cavale Blanche University Hospital, Department of General and Digestive Surgery, Brest, France
| | - Frédéric Marchal
- University of Lorraine, Cancer Institute of Lorraine, Department of Surgery, Vandœuvre-lès-Nancy Cedex, France
| | - Charles Sabbagh
- Amiens University Hospital, Department of Digestive Surgery, Amiens, France
| | - Momar Diouf
- Department of Clinical Research and Innovation, Amiens University Hospital, France
| | - Mehdi Karoui
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Digestive and Oncologic Surgery, Paris, France
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19
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Pang AJ, Marinescu D, Morin N, Vasilevsky CA, Boutros M. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach - an analysis of the ACS-NSQIP database. Surg Endosc 2022; 36:5652-5659. [PMID: 34973078 PMCID: PMC9283142 DOI: 10.1007/s00464-021-08926-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022]
Abstract
Introduction Fewer than 10% of colon cancers are found at the splenic flexure. A standard surgical approach to these cancers has not been defined. The goal of this study was to compare lymph node harvest and post-operative morbidity between segmental resection and formal left hemicolectomy for splenic flexure colon cancers. Method Patients diagnosed with a splenic flexure cancer were identified from the 2012–2018 ACS-NSQIP colectomy-targeted database. Patients were categorized based on type of surgical resection – left hemicolectomy with colorectal anastomosis or segmental colectomy with colocolonic anastomosis. Demographic, clinicopathologic, and post-operative outcomes were compared between groups. Factors independently associated with lymph node harvest, operative time, and post-operative morbidity were investigated by linear and binomial logistic regression models. Results A total of 3,049 patients underwent colectomy for a splenic flexure cancer. Of these, 83.6% had a segmental colectomy and 73% were performed by a minimally invasive approach. T- and N-stage did not differ between segmental and left hemicolectomy groups (p = 0.703 and p = 0.429, respectively). Inadequate nodal harvest (< 12 nodes) was infrequent and similar between the two procedures (7.4% vs. 9.1%, p = 0.13). Operative time was significantly shorter for segmental colectomy (213 ± 83.5 min vs. 193 ± 84.1 min, p < 0.0001) and major morbidity was similar between the two surgical techniques (8.4% vs. 8.9%, p = 0.75). After accounting for demographic, clinicopathologic, and operative factors, binomial logistic regression showed that type of procedure was not significantly associated with LN harvest (OR 0.80, 95%CI 0.54–1.17) or major morbidity (OR 1.17, 95%CI 0.36–3.81). However, on linear regression, segmental splenic flexure resection was associated with shorter operative time (estimate 20.29, 95%CI 12.61–27.97, p < 0.0001). Conclusion Splenic flexure resection for colon cancer is associated with an adequate lymph node harvest. Compared to a formal left hemicolectomy, a segmental resection also has a shorter operative time with equivalent post-operative morbidity.
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Affiliation(s)
- Allison J Pang
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada.
| | - Daniel Marinescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, Montréal, QC, Canada
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20
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Labiad C, Manceau G, Mege D, Cazelles A, Voron T, Bridoux V, Lakkis Z, Abdalla S, Karoui M. Emergency surgery for obstructive splenic flexure colon cancer: results of a multicentric study of the French Surgical Association (AFC). Updates Surg 2021; 74:107-115. [PMID: 34813043 DOI: 10.1007/s13304-021-01206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Management of malignant left-sided colonic obstruction remains challenging and requires a stoma in 40-65% of patients. In those with obstructive splenic flexure colon cancer (OSFCC), a debate still exists regarding the most appropriate surgery. The aim of this muticenter study was to report and compare the different surgical procedures in OSFCC patients with a special focus on operative and histological characteristics and survival outcomes including 12-month stoma-free survival. Between 2000 and 2015, 2325 patients were treated for obstructive colon cancer in centers members of the French National Surgical Association (AFC). Among them, 198 underwent surgery for OSFCC and were retrospectively analyzed. Patients with OSFCC and proximal colonic ischemia or perforation were excluded. Four procedures were performed: decompressing stoma (DS, 39%), splenic flexure colectomy (SFC, 39%), subtotal colectomy (STC, 17%,) and left hemicolectomy (LHC, 5%). All patients treated with LHC underwent a Hartmann's procedure. There was no significant difference between groups for postoperative mortality and morbidity. Hospital stay was significantly longer after DS. The length of the specimen, longitudinal resection margins and number of harvested lymph nodes were significantly higher in the STC group. There was no difference for overall and disease-free survival. Stoma-free survival was significantly lower after LHC (62%) in comparison with the other groups (p < 0.0001). At the end of follow-up, 50% of patients who underwent LHC had a permanent stoma. In OSFCC patients without proximal colonic ischemia or peritonitis, LHC should no longer be recommended due to a high risk of permanent stoma.
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Affiliation(s)
- Camélia Labiad
- Department of Digestive and Oncological Surgery, Paris University, Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Gilles Manceau
- Department of Digestive and Oncological Surgery, Paris University, Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France.
| | - Diane Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - Antoine Cazelles
- Department of Digestive and Oncological Surgery, Paris University, Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Thibault Voron
- Department of Digestive Surgery, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Saint Antoine University Hospital, Paris, France
| | - Valérie Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Zaher Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - Solafah Abdalla
- Department of Digestive Surgery, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital,, Le Kremlin-Bicêtre, France
| | - Mehdi Karoui
- Department of Digestive and Oncological Surgery, Paris University, Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
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21
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Kim MJ, Kim JH, Lee YS, Kye BH, Cho HM, Kim HJ, Kang WK. Short- and long-term outcomes of laparoscopic segmental left colectomy for splenic flexure colon cancer: comparison with propensity score matching. Ann Surg Treat Res 2021; 101:274-280. [PMID: 34796143 PMCID: PMC8564077 DOI: 10.4174/astr.2021.101.5.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Splenic flexure colon cancer (SFCC) is a rare disease that accounts for 2%–8% of colorectal cancers, and the extent of surgery and resection is still debatable. There have also been few studies on the safety and feasibility of laparoscopic surgery for SFCC. The purpose of this study is to evaluate outcomes and prognoses of surgery for SFCC. Methods We included patients with stage 1 to 3 who had undergone laparoscopic surgery for distal transverse-to-sigmoid colon cancer at 2 hospitals from March 2004 to December 2016 and collected data by retrospective design. We defined SFCC as being cancer between distal transverse and proximal descending colon. The short- and long-term outcomes of the anterior resection (AR) group (those patients who had undergone laparoscopic AR for mid and distal descending to sigmoid colon cancer) and the left colon resection (LR) group (those who had undergone laparoscopic segmental left colectomy for SFCC) were compared using propensity score matching. Results The median follow-up period was 60 months. The numbers of subjects in the AR and the LR groups were 948 and 118. After 2:1 propensity score matching, 236 vs. 118 patients were selected. There was no significant difference in 5-year disease-free survival (80.7% vs. 78.6%, P = 0.607), and both the 5-year overall survival (89.2% vs. 88.2%, P = 0.563) as well as short-term outcomes showed no statistical difference in most of the variables. Conclusion Laparoscopic segmental left colectomy can be one option among the standard procedures for SFCC.
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Affiliation(s)
- Moon Jin Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yoon Suk Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Hyeon Kye
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyeon Min Cho
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyung Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyung Kang
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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European multicenter propensity score match study of laparoscopic vs. open colectomy for splenic flexure carcinomas: Results from the Splenic Flexure Cancer (SFC) Study Group. J Visc Surg 2021; 159:373-382. [PMID: 34238728 DOI: 10.1016/j.jviscsurg.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM OF THE STUDY This European multicenter study aims to compare the results of laparoscopic versus laparotomy approach for the resection of splenic flexure colon carcinoma (SFC). PATIENTS AND METHODS Patients with SFC who required curative resection by laparoscopy (LAP) or laparotomy (OPEN) between 2000 and 2018 were included. Three types of interventions were considered: extended right hemi-colectomy, left hemi-colectomy and splenic flexure resection. The LAP and OPEN groups were matched according to propensity score and compared with Chi-square, Mann-Whitney tests, and multivariate regression models. Overall survival and recurrence-free survival were assessed using the Kaplan-Meier method. RESULTS The study population consisted of 399 patients, including 297 operated by LAP and 102 by OPEN. Extended right hemi-colectomy was performed in 35.8% of cases, left hemi-colectomy in 32.8% and splenic flexure resection in 31.4%. After propensity score matching, the LAP (n=64) and OPEN (n=64) groups were comparable for all pre-operative variables and tumor characteristics. The LAP group showed less blood loss and a shorter interval to return of transit and feeding compared to the OPEN group, regardless of the resection technique. There were no differences between the groups in terms of overall survival and 5-year recurrence-free survival. CONCLUSION These results support the application of laparoscopy for the resection of SFC.
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23
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Song I, Park JW, Lim HK, Kim MJ, Kim MJ, Park SC, Oh JH, Oh HK, Kim DW, Kang SB, Ryoo SB, Jeong SY, Park KJ. The oncologic safety of left colectomy with modified complete mesocolic excision for distal transverse colon cancer: Comparison with descending colon cancer. Eur J Surg Oncol 2021; 47:2857-2864. [PMID: 34119379 DOI: 10.1016/j.ejso.2021.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer. MATERIAL AND METHODS This study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. RESULTS Baseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786-3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530-2.952, p = 0.609). CONCLUSION The oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer.
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Affiliation(s)
- Inho Song
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Han-Kin Lim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Jo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Zhang T, Song Z, Zhang Y, Ji X, Jing X, Shi Y, Cheng X, Zhao R. Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer-a propensity score-matching analysis. J Gastrointest Oncol 2021; 12:944-952. [PMID: 34295547 DOI: 10.21037/jgo-21-221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background Splenic flexure cancer (SFC) is a rare condition in colorectal cancer (CRC). The appropriate surgical treatment for SFC remains controversial. In recent years, we have used artery-guided segmental splenic flexure colectomy (ASFC) to treat SFC in which robotic access is gradually applied. The study sought to assess the clinical and oncologic outcomes of robotic-assisted ASFC compared to laparoscopic-assisted ASFC for SFC by undertaking a propensity score-matching analysis. Methods Seventy patients underwent a robotic-assisted ASFC (n=19) or laparoscopic-assisted ASFC (n=51) to treat SFC from Dec 2015 to Dec 2019. Their data were prospectively collected. The patients were matched at a ratio of 1:1 according to sex, age, body mass index (BMI), comorbidities, the American Society of Anesthesiologists (ASA) score (≤2 or >2), previous abdominal surgeries, and pathologic stage. Results No statistically significant differences were found between the robotic- and laparoscopic-assisted ASFC groups in relation to operation time, estimated blood loss, length of postoperative hospital stay, time to liquid diet, postoperative complications, tumor size, distal resection margins, histology, lymph node harvest, metastatic lymph nodes, and neuro-vascular invasion. Additionally, no case was converted to a laparotomy. There were no cases readmission or mortality within 30 days of surgery. The distal resection margins were longer in the robotic-assisted ASFC group than the laparoscopic-assisted ASFC group. The robotic-assisted ASFC group had significantly higher operation expenses than the laparoscopic-assisted ASFC group. However, there was no significant difference in the surgical material expenses between the two groups. There were 2 cases of complications in each group; both cases were classified as grade I or II under Dindo's classification of surgical complications. Conclusions With the exception of operation expenses, robotic-assisted ASFC rivals laparoscopic-assisted ASFC in many respects. ASFC meets the recommended oncological criteria in terms of resection margins and lymph node harvest. We await the results for the long-term oncologic outcomes.
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Affiliation(s)
- Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zijia Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yaqi Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoqian Jing
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Shi
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xi Cheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ueda K, Daito K, Ushijima H, Yane Y, Yoshioka Y, Tokoro T, Iwamoto M, Wada T, Makutani Y, Kawamura J. Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes. Surg Endosc 2021; 36:2661-2670. [PMID: 34031741 PMCID: PMC8921072 DOI: 10.1007/s00464-021-08559-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
Background Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer is an essential procedure for improved oncologic outcomes after surgery. Laparoscopic surgery for splenic flexure colon cancer was recently adopted due to a greater understanding of surgical anatomy and improvements in surgical techniques and innovative surgical devices. Methods We retrospectively analyzed the data of patients with splenic flexure colon cancer who underwent laparoscopic CME with CVL at our institution between January 2005 and December 2017. Results Forty-five patients (4.8%) were enrolled in this study. Laparoscopic CME with CVL was successfully performed in all patients. The median operative time was 178 min, and the median estimated blood loss was 20 g. Perioperative complications developed in 6 patients (13.3%). The median postoperative hospital stay was 9 days. According to the pathological report, the median number of harvested lymph nodes was 15, and lymph node metastasis developed in 14 patients (31.1%). No metastasis was observed at the root of the middle colic artery or the inferior mesenteric artery. The median follow-up period was 49 months. The cumulative 5-year overall survival and disease-free survival rates were 85.9% and 84.7%, respectively. The cancer-specific survival rate in stage I-III patients was 92.7%. Recurrence was observed in 5 patients (11.1%), including three patients with peritoneal dissemination and two patients with distant metastasis. Conclusions Laparoscopic CME with CVL for splenic flexure colon cancer appears to be oncologically safe and feasible based on the short- and long-term outcomes in our study. However, it is careful to introduce this procedure to necessitate the anatomical understandings and surgeon’s skill. The appropriate indications must be established with more case registries because our experience is limited.
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Affiliation(s)
- Kazuki Ueda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan.
| | - Koji Daito
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Hokuto Ushijima
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yoshinori Yane
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yasumasa Yoshioka
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Tadao Tokoro
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Masayoshi Iwamoto
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Toshiaki Wada
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yusuke Makutani
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Junichiro Kawamura
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
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de'Angelis N, Espin E, Ris F, Landi F, Le Roy B, Coccolini F, Celentano V, Gurrado A, Pezet D, Bianchi G, Memeo R, Vitali GC, Solis A, Denet C, Di Saverio S, de'Angelis GL, Kraft M, Gonzálvez-Guardiola P, Stakelum A, Catena F, Fuks D, Winter DC, Testini M, Martínez-Pérez A. Emergency surgery for splenic flexure cancer: results of the SFC Study Group database. World J Emerg Surg 2021; 16:20. [PMID: 33926504 PMCID: PMC8086132 DOI: 10.1186/s13017-021-00365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
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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Affiliation(s)
- Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy.,University of Paris Est, UPEC, Créteil, France
| | - Eloy Espin
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Frederic Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Filippo Landi
- Department of General Surgery, Viladecans Hospital, Barcelona, Spain
| | - Bertrand Le Roy
- Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Valerio Celentano
- Minimally Invasive Colorectal Unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - Angela Gurrado
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Denis Pezet
- Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of HPB and Emergency Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Giulio C Vitali
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Alejandro Solis
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Christine Denet
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Salomone Di Saverio
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Gian Luigi de'Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Aine Stakelum
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - David Fuks
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Des C Winter
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Mario Testini
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Aleix Martínez-Pérez
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
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Yamamoto M, Taniguchi K, Tominaga T, Shibata M, Inomata Y, Komura K, Osumi W, Hamamoto H, Tanaka K, Okuda J, Uchiyama K. Evaluation of lymphatic flow pattern using indocyanine green fluorescence imaging in a highly metastatic mouse model. Cancer Sci 2020. [PMCID: PMC7894008 DOI: 10.1111/cas.14766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Recently, the feasibility of real‐time indocyanine green (ICG) fluorescence imaging–guided complete mesocolic excision in colon cancer surgery has been demonstrated; however, its application to the evaluation of lymphatic flow in widespread lymph node metastasis is uncertain. This study aimed to evaluate lymphatic flow using the real‐time ICG fluorescence imaging. A mouse model of subcutaneous inoculation of BJMC3879Luc2 cells, which have been demonstrated to highly metastasize to the lymph nodes, was used as an evaluation model. Tumor growth and lymphatic flow were monitored weekly by bioluminescent imaging and near‐infrared (NIR) fluorescence imaging, respectively. After sacrificing the mice, lymph node metastases were evaluated by bioluminescent imaging and histopathology. Lymphatic flows in a model of high lymph node metastasis were evaluated using NIR fluorescence imaging. Pathological metastases of bilateral axillary, femoral, and para‐aortic lymph nodes were detected in all inoculated mice (100%: 5/5). Real‐time NIR fluorescence imaging showed the primary lymphatic vessels staining through the metastatic lymph nodes as before the inoculation of the cancer cells. Hitherto, it has been considered that lymphatic flow was changed using the bypass pathway due to occlusion of the primary lymphatic vessels. In this presented study, real‐time ICG fluorescence imaging showed no changes in lymphatic flow after lymph node metastasis. Our results suggest that real‐time ICG fluorescence imaging may have potential for the guidance of colon cancer surgery in cases of widespread lymph node metastasis.
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Affiliation(s)
- Masashi Yamamoto
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Kohei Taniguchi
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
- Translational Research ProgramOsaka Medical College Takatsuki Japan
| | - Tomo Tominaga
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Masa‐Aki Shibata
- Department of Anatomy and Cell Biology Osaka Medical College Takatsuki Japan
| | - Yosuke Inomata
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Kazumasa Komura
- Translational Research ProgramOsaka Medical College Takatsuki Japan
| | - Wataru Osumi
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Hiroki Hamamoto
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Keitaro Tanaka
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Junji Okuda
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
| | - Kazuhisa Uchiyama
- Departments of General and Gastroenterological Surgery Osaka Medical College Takatsuki Japan
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Pedrazzani C, Turri G, Park SY, Hida K, Fukui Y, Crippa J, Ferrari G, Origi M, Spolverato G, Zuin M, Bae SU, Baek SK, Costanzi A, Maggioni D, Son GM, Scala A, Rockall T, Guglielmi A, Choi GS, Larson DW. Clinical-Pathologic Characteristics and Long-term Outcomes of Left Flexure Colonic Cancer: A Retrospective Analysis of an International Multicenter Cohort. Dis Colon Rectum 2020; 63:1593-1601. [PMID: 33149021 DOI: 10.1097/dcr.0000000000001785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colorectal cancer seldom presents at the splenic flexure. Small series on left flexure tumors reported a high occurrence of negative prognostic factors called into question as causes of poor prognosis. However, because of the small number of cases, no definite conclusions can be drawn. OBJECTIVE The aim of this study was to compare clinical-pathologic characteristics and short- and long-term outcomes of left flexure tumors with other colonic locations. DESIGN This was a retrospective analysis of consecutive patients who underwent surgery for tumors at the splenic flexure. Each tumor was paired in a 1 to 1 fashion with a right-sided and sigmoid tumor. SETTINGS The study was conducted in 10 international centers. PATIENTS A total of 641 patients with left flexure tumors were included in the study. MAIN OUTCOME MEASURES Overall survival and cancer-specific survival were measured. RESULTS Left flexure tumors presented more frequently with stenosis (30.5%; p < 0.001), with lesions infiltrating beyond the serosa (21.9%; p = 0.001) and with a high rate of mucinous histology (8.8%; p = 0.001). Looking at long-term prognosis, no differences were observed among the 3 groups, both considering overall and cancer-specific survival. However, left flexure tumors recurred more frequently as peritoneal carcinomatosis (20.6%; p < 0.001). LIMITATIONS This study was limited because of its retrospective nature. CONCLUSIONS Although left flexure tumors display several negative prognostic factors, they are not characterized by a worse prognosis compared with other colon cancer locations. See Video Abstract at http://links.lww.com/DCR/B395. CARACTERÍSTICAS CLÍNICO-PATOLÓGICAS Y RESULTADOS A LARGO PLAZO DEL CÁNCER DE COLON DE ÁNGULO IZQUIERDO: UN ANÁLISIS RETROSPECTIVO DE UNA COHORTE MULTICÉNTRICA INTERNACIONAL: El cáncer colorrectal rara vez se presenta en el ángulo esplénico. Pequeñas series sobre tumores de ángulo izquierdo informaron una alta incidencia de factores pronósticos negativos cuestionados como causas de mal pronóstico. Sin embargo, debido al pequeño número de casos, no se pueden sacar conclusiones definitivas.El objetivo de este estudio fue comparar las características clínico-patológicas, los resultados a corto y largo plazo de los tumores de ángulo izquierdo con otras ubicaciones de colon.Análisis retrospectivo de pacientes consecutivos que se sometieron a cirugía por tumores en el ángulo esplénico. Cada tumor se emparejó de forma individual con un tumor del lado derecho y sigmoide.El estudio se realizó en 10 centros internacionales.Se incluyeron en el estudio un total de 641 pacientes con tumores del ángulo izquierdo.Supervivencia general y específica del cáncerLos tumores de ángulo izquierda se presentaron con mayor frecuencia con estenosis (30.5%, p <0.001), con lesiones infiltradas más allá de la serosa (21.9%, p = 0.001), y con una alta tasa de histología mucinosa (8.8%, p = 0.001). En cuanto al pronóstico a largo plazo, no se observaron diferencias entre los tres grupos, considerando la supervivencia general y específica del cáncer. Sin embargo, los tumores de ángulo izquierdo recurrieron con mayor frecuencia como carcinomatosis peritoneal (20,6%; p <0,001).Este estudio fue limitado debido a su naturaleza retrospectiva.Aunque los tumores de ángulo izquierdo muestran varios factores pronósticos negativos, no se caracterizan por un peor pronóstico en comparación con otras ubicaciones de cáncer de colon. Consulte Video Resumen en http://links.lww.com/DCR/B395.
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Affiliation(s)
- Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Giulia Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yudai Fukui
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Jacopo Crippa
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
| | - Giovanni Ferrari
- Department of General Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Origi
- Department of General Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gaya Spolverato
- First Surgical Clinic Section, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Matteo Zuin
- First Surgical Clinic Section, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Sung Uk Bae
- Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Seong Kyu Baek
- Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Andrea Costanzi
- General Surgery Unit, San Leopoldo Mandic Hospital Merate, ASST Lecco, Italy
| | - Dario Maggioni
- General Surgery Unit, San Leopoldo Mandic Hospital Merate, ASST Lecco, Italy
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea
| | - Andrea Scala
- Department of Colorectal and Minimal Access Surgery, Royal Surrey National Health Service Foundation Trust, Guildford, United Kingdom
| | - Timothy Rockall
- Department of Colorectal and Minimal Access Surgery, Royal Surrey National Health Service Foundation Trust, Guildford, United Kingdom
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Gyu Seog Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - David W Larson
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
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Hajibandeh S, Hajibandeh S, Hussain I, Zubairu A, Akbar F, Maw A. Comparison of extended right hemicolectomy, left hemicolectomy and segmental colectomy for splenic flexure colon cancer: a systematic review and meta-analysis. Colorectal Dis 2020; 22:1885-1907. [PMID: 32757361 DOI: 10.1111/codi.15292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
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, 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. 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 -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. 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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Affiliation(s)
- S Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - S Hajibandeh
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK
| | - I Hussain
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - A Zubairu
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - F Akbar
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - A Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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30
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Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kato S, Hanaoka M. Which is more important in the management of splenic flexure colon cancer: strict central lymph node dissection or adequate bowel resection margin? Tech Coloproctol 2020; 24:873-882. [PMID: 32548666 DOI: 10.1007/s10151-020-02260-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND What qualifies as optimal lymph node (LN) dissection in the surgical management of splenic flexure colon cancer (SFCC) still remains controversial because few studies have evaluated the distribution of LN metastasis of SFCC. The aim of this study was to clarify detailed distribution of LN metastasis and long-term outcomes of SFCC. METHODS This retrospective study enrolled patients who had curative colectomy for primary transverse or descending colon cancer of pathological stage I, II, or III at a single high-volume cancer center between April 2002 and December 2018. The 538 eligible patients were divided into three groups: patients with SFCC (SFCC group, n = 168), patients with proximal transverse colon cancer (PTCC group, n = 290), and patients with distal descending colon cancer (DDCC group, n = 80). LNs were classified into horizontal (pericolic) and vertical (intermediate and main) nodes. Intermediate and main LN station numbers were defined according to the Japanese Society for Cancer of the Colon and Rectum classification. Distributions of LN metastasis and long-term outcomes were compared. RESULTS In the SFCC group, the mean age was 67.3 ± 10.5 years and 110 patients (65.5%) were male. The proportion of patients with LN metastasis in the intermediate or main region was significantly lower in the SFCC group (8%) than in the PTCC (37%) (p < 0.01) or DDCC group (29%) (p < 0.01) in pathological stage III patients. In the SFCC group, the incidence of pericolic LN metastasis on the oral side of tumor (43%) was significantly higher than in the PTCC group (21%) (p < 0.01) and was similar to that in the DDCC group (42%) (p = 0.51), while in the SFCC group, the incidence of pericolic LN metastasis on the anal side of tumor (17%) was lower than in the PTCC group (31%) and was also similar to that in the DDCC group (21%). There were no significant differences in disease-specific survival rates among all groups. CONCLUSIONS LN metastasis occurred mainly in the pericolic region, especially on the oral side of the tumor in SFCC. It may, therefore, be important to have an adequate bowel resection margin, especially on the oral side, for SFCC.
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Affiliation(s)
- Y Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - A Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - H Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - H Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - S Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - S Kato
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - M Hanaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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A three-dimensional computed tomography angiography study of the anatomy of the accessory middle colic artery and implications for colorectal cancer surgery. Surg Radiol Anat 2020; 42:1509-1515. [PMID: 32500228 PMCID: PMC7644475 DOI: 10.1007/s00276-020-02511-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
Abstract
Purpose In the present study, we focused on the accessory middle colic artery and aimed to increase the safety and curative value of colorectal cancer surgery by investigating the artery course and branching patterns. Methods We included 143 cases (mean age, 70.4 ± 11.2 years; 86 males) that had undergone surgery for neoplastic large intestinal lesions at the First Department of Surgery at Yamagata University Hospital between August 2015 and July 2018. We constructed three-dimensional (3D) computed tomography (CT) angiograms and fused them with reconstructions of the large intestines. We investigated the prevalence of the accessory middle colic artery, the variability of its origin, and the prevalence and anatomy of the arteries accompanying the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery. Results Accessory middle colic artery was observed in 48.9% (70/143) cases. This arose from the superior mesenteric artery in 47, from the inferior mesenteric artery in 21, and from the celiac artery in two cases. In 78.2% (112/143) cases, an artery accompanying the inferior mesenteric vein was present at the same level as the origin of the inferior mesenteric artery; this artery was the left colic artery in 92, the accessory middle colic artery in 11, and it divided and became the left colic artery and the accessory middle colic artery in 10 cases. Conclusion 3D CT angiograms are useful for preoperative evaluation. Accessory middle colic arteries exist and were observed in 14.9% of cases.
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Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc 2020; 35:661-672. [PMID: 32072288 DOI: 10.1007/s00464-020-07431-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The surgical resection of the splenic flexure carcinoma (SFC) is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs. METHODS This retrospective multicenter study analyzed the surgical and oncological outcomes of SFC patients undergoing elective curative intent surgery between 2000 and 2018. Descriptive and exploratory analyses were first conducted on the whole sample. Outcomes of the different procedures (ERC vs. LC vs. SLC) were then compared using propensity score matching for multilevel treatment. Overall (OS) and disease-free survival (DFS) were evaluated by Kaplan-Meier method. RESULTS From a total of 399 SFC patients, 143 (35.8%) underwent ERC, 131 (32.8%) underwent LC, and 125 (31.4%) underwent SLC. Overall, 297 (74.4%) were laparoscopic procedures. An increase in operative time, time to flatus, time to regular diet, and hospital stay was observed with the progressive extension of SFC resection. ERC was associated with significantly increased risk of postoperative ileus compared to both LC and SLC. A significantly greater number of lymph nodes were retrieved by ERC, but the objective of at least 12 retrieved lymph nodes was achieved in 85% of patients, without procedure-related differences. No differences were observed in OS or DFS between ERC, LC, and SLC. CONCLUSION The present study supports the resection of SFCs by colon-sparing surgical techniques, such as SLC.
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Binda GA, Amato A, Alberton G, Bruzzone M, Secondo P, Lòpez-Borao J, Giudicissi R, Falato A, Fucini C, Bianco F, Biondo S. Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short-term outcomes. Colorectal Dis 2020; 22:146-153. [PMID: 31454443 DOI: 10.1111/codi.14832] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/02/2019] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- G A Binda
- Department of Surgery, Galliera Hospital, Genoa, Italy
| | - A Amato
- Unit of Coloproctology, Hospital of Sanremo, Sanremo, Italy
| | - G Alberton
- Department of Surgery, Galliera Hospital, Genoa, Italy
| | - M Bruzzone
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - P Secondo
- Unit of Coloproctology, Hospital of Sanremo, Sanremo, Italy
| | - J Lòpez-Borao
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, Barcelona, Spain.,IDIBELL, University of Barcelona, Barcelona, Spain
| | - R Giudicissi
- Department of Medical Surgical Critical Care, Careggi Hospital, Florence, Italy
| | - A Falato
- Abdominal Oncology Department, Istituto Nazionale Tumori, IRCCS, G. Pascale, Naples, Italy
| | - C Fucini
- Department of Medical Surgical Critical Care, Careggi Hospital, Florence, Italy
| | - F Bianco
- Abdominal Oncology Department, Istituto Nazionale Tumori, IRCCS, G. Pascale, Naples, Italy
| | - S Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, Barcelona, Spain.,IDIBELL, University of Barcelona, Barcelona, Spain
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Manceau G, Benoist S, Panis Y, Rault A, Mathonnet M, Goere D, Tuech JJ, Collet D, Penna C, Karoui M. Elective surgery for tumours of the splenic flexure: a French inter-group (AFC, SFCD, FRENCH, GRECCAR) survey. Tech Coloproctol 2020; 24:191-198. [PMID: 31939046 DOI: 10.1007/s10151-019-02143-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In an elective setting, there is no consensus regarding the type of colectomy that is best for patients with tumors of the splenic flexure: segmental left colectomy (or splenic flexure colectomy), left hemicolectomy or subtotal colectomy (or extended right hemicolectomy). In the United Kingdom, extended right hemicolectomy is preferred by surgeons. The aim of the present survey was to report on the practices in France for this particular tumor location. METHODS Between 15/07/17 and 15/10/17, members of two French surgical societies [the French Association of Surgery (AFC) and the French Society of Digestive Surgery (SFCD)] and two French surgical cooperative groups [the French Federation of Surgical Research (FRENCH) and the French Research Group of Rectal Cancer Surgery (GRECCAR)] were solicited by email to answer an online anonymous questionnaire. RESULTS A total of 190 out of 420 surgeons participated in this study (response rate 45%). The preferred procedure was splenic flexure colectomy (70%), followed by left hemicolectomy (17%) and subtotal colectomy (13%). The most used surgical approach was laparoscopy (63%), followed by laparotomy (31%) and hand-assisted laparoscopy (6%). Lymph node dissection was extended to the middle colic artery in 29% of splenic flexure colectomies and in 33% of left hemicolectomies. Twenty-nine percent of responders thought that tumors of the splenic flexure had a worse prognosis in comparison with other colonic sites, because of insufficient lymph node dissection (73%) or a more advanced stage (50%) at diagnosis. However, this opinion did not change the type of colectomy performed. CONCLUSIONS There is a strong consensus in France to operate tumors of the splenic flexure with a splenic flexure colectomy and lymph node dissection limited to the left colic artery.
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Affiliation(s)
- G Manceau
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - S Benoist
- Department of Surgery, Assistance Publique - Hôpitaux de Paris, Bicetre Hospital, Université Paris Sud, Le Kremlin-Bicetre, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - A Rault
- Department of Digestive and General Surgery Service, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - M Mathonnet
- Department of Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges University, Limoges, France
| | - D Goere
- Department of Visceral and Oncologic Surgery, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - J J Tuech
- Department of Digestive and General Surgery, Charles Nicolle Hospital, Rouen University, Rouen, France
| | - D Collet
- Department of Digestive Surgery, Haut-Levêque University Hospital, Bordeaux University, Bordeaux, France
| | - C Penna
- Department of Surgery, Assistance Publique - Hôpitaux de Paris, Bicetre Hospital, Université Paris Sud, Le Kremlin-Bicetre, France
| | - M Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
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Tejedor P, Sagias F, Khan J. Lymphatic drainage of a splenic flexure tumour defined by intra-operative indocyanine green mapping - a video vignette. Colorectal Dis 2020; 22:106-107. [PMID: 31441984 DOI: 10.1111/codi.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/29/2019] [Indexed: 02/08/2023]
Affiliation(s)
- P Tejedor
- Colorectal Surgery, Portsmouth Hospitlas NHS Trust, Portsmouth, UK
| | - F Sagias
- Colorectal Surgery, Portsmouth Hospitlas NHS Trust, Portsmouth, UK
| | - J Khan
- Colorectal Surgery, Portsmouth Hospitlas NHS Trust, Portsmouth, UK.,School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
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Chenevas-Paule Q, Trilling B, Sage PY, Girard E, Faucheron JL. Laparoscopic segmental left colectomy for splenic flexure carcinoma: a single institution experience. Tech Coloproctol 2019; 24:41-48. [PMID: 31834555 DOI: 10.1007/s10151-019-02126-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is ongoing debate regarding surgical treatment of splenic flexure cancer. The main points of controversy include the appropriate extent of colon resection, either to the right or to the left, and the appropriate extent of lymph-node dissection. The aim of this study was to review our experience in laparoscopic treatment of splenic flexure cancer cases and to compare our data to the recent literature. METHODS Consecutive patients, operated on for splenic flexure colon carcinoma at a single institution between April 2005 and January 2013, were included in the study. Exclusion criteria were a previous history of colorectal cancer, recurrent colonic cancer, emergency cases with an obstructive tumor or a perforated tumor with peritonitis, synchronous cancer, palliative surgery, and a past history of colorectal resection. Patients underwent laparoscopic segmental left colectomy with ligation of the left branch of the middle colic and of the left colic artery. Patient characteristics, operative and postoperative outcomes, and long-term technical, functional, and oncological results from a prospectively maintained database were retrospectively analyzed. After hospital discharge, standardized follow-up was performed at 1 month postoperatively, then every 3 months during the first 2 years, and every 6 months thereafter, for a total of 5 years. RESULTS A total of 28 consecutive patients (16 males) with a median age of 71.8 years (range 42.5-88.8 years) were included. Ninety-day mortality was 3.5% and surgical morbidity was 21.5% with anastomotic leak rate of 10.7%. All survivors experienced good or very good functional results. During a median follow-up period of 50.9 months, eight patients (28.5%) presented with a recurrence. The 5-year overall and disease-free survival rates were 46.3% and 39.2%, respectively. CONCLUSIONS Segmental left colectomy for splenic flexure carcinoma is associated with reasonably low morbidity and very good functional results. However, survival rates are low.
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Affiliation(s)
- Q Chenevas-Paule
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000, Grenoble, France
| | - B Trilling
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000, Grenoble, France.,University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - P Y Sage
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000, Grenoble, France
| | - E Girard
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000, Grenoble, France.,University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - J L Faucheron
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000, Grenoble, France. .,University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France. .,Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France.
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Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G, Testa S, Carlini M. Intracorporeal Versus Extracorporeal Anastomosis for Laparoscopic Resection of the Splenic Flexure Colon Cancer: A Multicenter Propensity Score Analysis. Surg Laparosc Endosc Percutan Tech 2019; 29:483-488. [PMID: 30817694 DOI: 10.1097/sle.0000000000000653] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study is to compare the short and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) during laparoscopic resection of splenic flexure for cancer, in 3 high-volume Italian centers. MATERIALS AND METHODS A retrospective analysis was conducted on a multicenter database of a consecutive series of patients who underwent an elective laparoscopic resection of the splenic flexure for colon cancer in 3 high-volume centers between January 2008 and August 2017. Propensity score matching analysis was performed to overcome patients' selection bias between the 2 surgical techniques. Data on patients' demographics, operative details, short-term and long-term outcomes were prospectively recorded. RESULTS In total, 102 patients were selected. After propensity score match, 72 patients were compared: 36 for the IA group, 36 for the EA group. The IA group showed a significantly shorter median time to first flatus, time to first stool, time to oral feeding, and time to discharge, as well as significantly lower incidence of postoperative severe surgical complications, especially in terms of wound infections, and of incisional hernia (IH).Risk factors for IH on logistic regression were longer operative time, EA, longer incision, postoperative blood transfusions, and longer specimen. CONCLUSIONS The IA in laparoscopic resection of the splenic flexure is feasible and safe in terms of short-term and long-term outcomes. Major advantages are shorter time to first flatus and first stool, complete oral feeding and time to discharge, with minor incidence of severe surgical complications, such as wound infection, and lower incidence of IH.
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Affiliation(s)
- Michele Grieco
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo
| | - Diletta Cassini
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo, Abano Terme (PD)
| | - Domenico Spoletini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo
| | - Enrica Soligo
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate, Vercelli, Italy
| | - Emanuela Grattarola
- Statistical and Big Data Department, Elis Consulting & Labs, Via S. Sandri, Rome
| | - Gianandrea Baldazzi
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo, Abano Terme (PD)
| | - Silvio Testa
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate, Vercelli, Italy
| | - Massimo Carlini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo
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Bracale U, Merola G, Pignata G, Corcione F, Pirozzi F, Cuccurullo D, De Palma GD, Cassinotti E, Sciuto A, Boni L. Laparoscopic resection with complete mesocolic excision for splenic flexure cancer: long-term follow-up data from a multicenter retrospective study. Surg Endosc 2019; 34:2954-2962. [PMID: 31451917 DOI: 10.1007/s00464-019-07078-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
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Rega D, Pace U, Scala D, Chiodini P, Granata V, Fares Bucci A, Pecori B, Delrio P. Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center. Sci Rep 2019; 9:10953. [PMID: 31358904 PMCID: PMC6662908 DOI: 10.1038/s41598-019-47548-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/11/2019] [Indexed: 12/29/2022] Open
Abstract
Extended right or left hemicolectomy are the most common surgical treatments for splenic flexure colon cancer. Extended resection (including distal pancreasectomy and/or splenectomy), has been often indicated for the treatment for the splenic flexure cancer, because the lymphatic drainage at this site is poorly defined and assumed as heterogeneous. Between January 2006 and May 2016, 103 patients with splenic flexure colon cancer were enrolled in the study. We evaluated the clinicopathological findings and outcomes of all patients and associated them to the different surgical treatment. Out of 103 selected cases an extended right hemicolectomy was performed in 22 (21.4%) patients, an extended left hemicolectomy in 24 (23.3%) patients, a segmental resection of the splenic flexure in 57 (55.3%) patients; the combined resection of adjacent organs showing tumor adherence was carried out in 11 (10.7%) patients. The tumor infiltrated near organs (T4) in 5 patients. No significant differences in complications were found among the three groups. In all groups no differences were found in the total number of harvested lymphnodes. After a median follow-up of 42 months, 30 recurrences and 19 deaths occurred (12 for tumor progression). There was no difference in overall and progression free survival among the three different surgical treatments. According to our results, the partial resection of splenic flexure was not associated with a worse prognosis and it was leading for a satisfactory oncological outcome. It is our opinion that the extended surgery is seldomly indicated to cure splenic flexure cancer.
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Affiliation(s)
- Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy.
| | - Ugo Pace
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy
| | - Dario Scala
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Vincenza Granata
- Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy
| | - Andrea Fares Bucci
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy
| | - Biagio Pecori
- Radiotherapy Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy
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Grieco M, Cassini D, Spoletini D, Soligo E, Grattarola E, Baldazzi G, Testa S, Carlini M. Laparoscopic resection of splenic flexure colon cancers: a retrospective multi-center study with 117 cases. Updates Surg 2019; 71:349-357. [PMID: 30406933 DOI: 10.1007/s13304-018-0601-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
The objective is to investigate the short- and long-term outcomes of laparoscopic resections of splenic flexure colon cancers in three Italian high-volume centers. The laparoscopic resection of splenic flexure colon cancers is a challenging procedure and has not been completely standardized, mainly due to the technical difficulty, the arduous identification of major blood vessels, and the problems associated with anastomosis construction. In this retrospective cohort observational study, a consecutive series of patients treated in three Italian high-volume centers with elective laparoscopic resection of the splenic flexure for cancer is analyzed. The observational period was from January 2008 to August 2017. Patient demographics and clinical features, operative data, and short- and long-term outcomes were prospectively recorded in a specific database and were retrospectively analyzed. During the observation period, 117 patients were selected. Conversion to open surgery was necessary in 15 patients (12.8%). Of 102 complete laparoscopic procedures, multi-visceral resection was performed in 13 cases (12.7%). Postoperative surgical complications occurred in 13 patients (12.7%), with 3 cases of anastomotic leak (2.9%) and 3 cases of re-operation (2.9%). The postoperative mortality in this population was null. The 5-year overall survival rate was 84.3%, and the 5-year disease-free survival rate was 87.8%. Laparoscopic resection of the splenic flexure is feasible and safe in high-volume centers. Compared to the results of other laparoscopic colonic resections, the short- and long-term outcomes are similar, but the conversion rate is higher.
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Affiliation(s)
- Michele Grieco
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - Diletta Cassini
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo 1, 35031, Abano Terme, PD, Italy
| | - Domenico Spoletini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Enrica Soligo
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate 21, 13100, Vercelli, Italy
| | - Emanuela Grattarola
- Statistical and Big Data Department, Elis Consulting & Labs, Via S. Sandri 81, 00159, Rome, Italy
| | - Gianandrea Baldazzi
- General and Minimally Invasive Surgery, Policlinico Abano Terme, Piazza C. Colombo 1, 35031, Abano Terme, PD, Italy
| | - Silvio Testa
- General Surgery Department, S. Andrea Hospital, Corso M. Abbiate 21, 13100, Vercelli, Italy
| | - Massimo Carlini
- General Surgery Department, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
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Bademci R, Bollo J, Martinez Sanchez C, Hernadez P, Targarona EM. Is Segmental Colon Resection an Alternative Treatment for Splenic Flexure Cancer? J Laparoendosc Adv Surg Tech A 2019; 29:621-626. [PMID: 30950767 DOI: 10.1089/lap.2019.0041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Refik Bademci
- Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Jesus Bollo
- Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - C Martinez Sanchez
- Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Pilar Hernadez
- Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Eduardo Maria Targarona
- Division of Colorectal Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
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Reddavid R, Esposito L, Evangelista A, Sofia S, Degiuli M. Non-anatomical colonic resections: splenic flexure and transverse colectomy. Central vascular ligation is crucial for survival. MINERVA CHIR 2019; 74. [DOI: 10.23736/s0026-4733.18.07803-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Manceau G, Mori A, Bardier A, Augustin J, Breton S, Vaillant JC, Karoui M. Lymph node metastases in splenic flexure colon cancer: Is subtotal colectomy warranted? J Surg Oncol 2018; 118:1027-1033. [PMID: 30212600 DOI: 10.1002/jso.25169] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Tumors of the splenic flexure (TSF) can be associated with metastatic lymph nodes (LN) along the left colic pedicle, but also along the superior mesenteric vessels. We aimed to detail the anatomical distribution of metastatic LNs in patients undergoing elective subtotal colectomy for TSF. METHOD Between 2000 and 2016, 65 patients were included. At pathological analysis, LNs were classified into two groups: locoregional LN (along the left colic artery) and distant LN (along the middle colic, right colic, and ileocolic arteries). RESULTS The median number of LNs examined was 20. Eighteen patients (27%) were pN+. Among them, six (33% of pN+ patients and 9% of the series) had at least one positive distant LN. All these patients had a positive distant LN along the right colic artery. These patients had a significantly advanced stage and more positive LNs than the others (stage III-IV: 100% vs 22%, P = 0.0009 and 6 [3-15] vs 0 [0-15], P < 0.0001, respectively). The presence of synchronous metastases was predictor of metastatic distant LNs (P = 0.042). CONCLUSION Elective subtotal colectomy for TSF allows to discover distant positive LNs in nearly 10% of patients. For those having TSF and synchronous metastatic disease enable to resection, subtotal colectomy should be recommended.
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Affiliation(s)
- Gilles Manceau
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Arnaud Mori
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Armelle Bardier
- Department of Pathology, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Jeremy Augustin
- Department of Pathology, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Sylvie Breton
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Jean-Christophe Vaillant
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
| | - Mehdi Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique, Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Medicine Sorbonne University, France
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Propensity score analysis of postoperative and oncological outcomes after surgical treatment for splenic flexure colon cancer. Int J Colorectal Dis 2018; 33:1201-1213. [PMID: 29845387 DOI: 10.1007/s00384-018-3063-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The surgical treatment of splenic flexure colon cancer (SFCC) is somehow not yet well standardized. Postoperative and oncological results of the three surgical techniques most commonly used to treat SFCC: extended right colectomy (ERC), egmental left colectomy (SLC), and left colectomy (LC) were evaluated. METHODS The study included all patients with stage I-III SFCC treated by ERC, SLC, or LC between 2005 and 2016. Postoperative and long-term outcomes after the different surgical techniques were analyzed: Propensity score matching (PSM) was performed to compare the outcomes between these surgical techniques and survival analyses were performed using the Kaplan-Meier method and log-rank tests. RESULTS A total of 170 SFCC patients were operated; ERC was performed in 71 (41.76%), SLC in 36 (21.18%), and LC in 63 (37.06%). There were no significant differences in the short and long-term postoperative outcomes. Three comparison groups were developed so that PSM could be performed between the surgical technique cases: ERC (n = 59) vs. LC (n = 50); ERC (n = 50) vs. SLC (n = 33); and SLC (n = 32) vs. LC (n = 44). No differences in the short or long-term outcomes of these techniques were observed. CONCLUSION The short and long-term outcomes between ERC, SLC, and LC are similar. SLC should be considered oncologically as appropiate as the other more extensive resections.
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Kim JC, Lee JL, Yoon YS, Kim CW, Park IJ, Lim SB. Robotic left colectomy with complete mesocolectomy for splenic flexure and descending colon cancer, compared with a laparoscopic procedure. Int J Med Robot 2018; 14:e1918. [PMID: 29790253 DOI: 10.1002/rcs.1918] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/09/2018] [Accepted: 04/01/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Its relatively low incidence and its surgical complexity mean that a standardized technique for left colectomy has not yet been established for splenic flexure and descending colon cancer (SF-DCC). METHODS Seventy-three patients (robot-assisted left colectomy with complete mesocolectomy [R-LCCM], n = 20; laparoscopic left colectomy with complete mesocolectomy [L-LCCM], n = 53) with SF-DCC were enrolled at the Asan Medical Center (Seoul, Korea). RESULTS R-LCCM conveniently enables dexterous dissection for the multi-directional approaches during left mesocolic mobilization. A conversion to open surgery was required in two patients of the L-LCCM group, but not in the R-LCCM group. A positive circumferential resection margin was exclusively identified in two patients in the L-LCCM group. Mean lymph node harvest was 21 with no difference between the two groups. CONCLUSIONS Although R-LCCM provided few remarkable advantages over L-LCCM, it could be considered as an efficient approach in patients with SF-DCC.
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Affiliation(s)
- Jin Cheon Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Jong Lyul Lee
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Yong Sik Yoon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Chan Wook Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - In Ja Park
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Seok-Byeong Lim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
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Abstract
BACKGROUND The optimal surgical management of splenic flexure cancer is debated, partly because of an incomplete understanding of the lymphatic drainage of this region. OBJECTIVE This study aimed to evaluate the normal lymphatic drainage of the human splenic flexure using laparoscopic scintigraphic mapping. DESIGN This was a clinical trial. SETTINGS The study was conducted at a single tertiary care center. PATIENTS Thirty consecutive patients undergoing elective colorectal resections without splenic flexure pathology were recruited. INTERVENTION Technetium-99m was injected subserosally at the splenic flexure. MAIN OUTCOME MEASURES Lymphatic scintigraphic mapping was undertaken at 15, 30, and 60 minutes using a laparoscopic gamma probe at the left branch of the middle colic, left colic, inferior mesenteric, and ileocolic (control) lymphovascular pedicles. RESULTS Lymphatic drainage at 60 minutes was strongly dominant in the direction of the left colic pedicle (96% of patients), with a median gamma count of 284 (interquartile range, 113-413), versus the left branch of the middle colic count of 31 (interquartile range, 15-49; p < 0.0001). This equated to a median 9.2-times greater flow to the left colic versus the middle colic. Counts at the left colic were greater than all of the other mapped sites at 15, 30, and 60 minutes (p < 0.001), whereas middle colic and inferior mesenteric artery counts were equivalent. The protocol increased operative duration by 20 to 30 minutes without complications. LIMITATIONS These results report lymphatic drainage from patients with normal splenic flexures, and caution is necessary when extrapolating to patients with splenic flexure cancers. CONCLUSIONS The lymphatic drainage of the normal splenic flexure is preferentially directed toward the left colic in the high majority of cases. Retrieving these nodes should be prioritized in splenic flexure cancer resections, with important secondary emphasis on left middle colic nodes, supporting segmental (left hemicolectomy) resection as the procedure of choice. Additional development of colonic sentinel node mapping using these techniques may contribute to individualized surgical therapy morbidity. See Video Abstract at http://links.lww.com/DCR/A495.
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Surgical Treatment of Colon Cancer of the Splenic Flexure: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2017; 27:318-327. [PMID: 28796653 DOI: 10.1097/sle.0000000000000419] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Beisani M, Vallribera F, García A, Mora L, Biondo S, Lopez-Borao J, Farrés R, Gil J, Espin E. Subtotal colectomy versus left hemicolectomy for the elective treatment of splenic flexure colonic neoplasia. Am J Surg 2017; 216:251-254. [PMID: 28709626 DOI: 10.1016/j.amjsurg.2017.06.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/05/2017] [Accepted: 06/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Optimal elective surgical treatment for splenic flexure neoplasm (SFN) is unclear. Subtotal colectomy (STC) and left hemicolectomy (LHC) are the two more common strategies used. METHODS Observational multicentric study comparing postoperative morbidity, mortality and long-term survival on patients with SFN electively operated by STC versus LHC between 2003 and 2014. RESULTS After revision of the databases, 144 patients were included (STC group, n = 68; LHC group, n = 76). No differences were found on epidemiological and surgical data. A higher global morbidity (58%vs37%, p = 0.014), surgical morbidity (50%vs33%, p = 0.037), postoperative ileus (37%vs20%, p = 0.023) and harvested lymph nodes (26vs18, p = 0.0001) were found on the STC group. No significant differences in complications according to severity, reoperation rate, hospital stay, mortality, recurrence or long-term survival were found between groups. CONCLUSIONS A higher surgical morbidity was found on the STC group, mainly due to mild postoperative ileus. No differences on long-term oncological results were found.
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Affiliation(s)
- Marc Beisani
- Department of Surgery, Colorectal Unit, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebrón 119-129, 08035, Barcelona, Spain.
| | - Francesc Vallribera
- Department of Surgery, Colorectal Unit, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebrón 119-129, 08035, Barcelona, Spain.
| | - Albert García
- Department of Surgery, Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain.
| | - Laura Mora
- Department of Surgery, Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain.
| | - Sebastiano Biondo
- Department of Surgery, Colorectal Unit, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jaime Lopez-Borao
- Department of Surgery, Colorectal Unit, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ramon Farrés
- Department of Surgery, Hospital Universitari de Girona Ramon Trueta, Avinguda de França, s/n, 17007, Girona, Spain.
| | - Júlia Gil
- Department of Surgery, Hospital Universitari de Girona Ramon Trueta, Avinguda de França, s/n, 17007, Girona, Spain.
| | - Eloy Espin
- Department of Surgery, Colorectal Unit, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebrón 119-129, 08035, Barcelona, Spain.
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Fukuoka A, Sasaki T, Tsukikawa S, Miyajima N, Ostubo T. Evaluating distribution of the left branch of the middle colic artery and the left colic artery by CT angiography and colonography to classify blood supply to the splenic flexure. Asian J Endosc Surg 2017; 10:148-153. [PMID: 28008722 DOI: 10.1111/ases.12349] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 09/30/2016] [Accepted: 10/16/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION CT angiography has gained widespread acceptance for preoperative evaluation of blood supply in patients with colorectal cancer. However, there have been few reports that pertain to the splenic flexure, for which surgery is technically difficult. We used preoperative CT angiography and CT colonography to evaluate blood supply to the splenic flexure. METHODS We defined the splenic flexure as the junction of the distal third of the transverse colon and the proximal third of the descending colon. We reviewed 191 cases and considered the descending colon as divided into the proximal third and the distal two-thirds; we then determined which part of the descending colon the left colic artery (LCA) entered. We also considered the transverse colon as divided into the proximal two-thirds and the distal third, and evaluated which part of the transverse colon the left branch of the middle colic artery entered. RESULT We classified blood supply to the splenic flexure into six types, described by the feeder vessels: type 1, the LCA (39.7%); type 2, the left branch of the middle colic artery (17.8%); type 3, the LCA and the left branch of the middle colic artery (9.9%); type 4, the accessory left colic artery (4.1%); type 5, the LCA and the accessory left colic artery (2.6%); and type 6, the marginal artery (25.6%). CONCLUSION We classified blood supply to the splenic flexure into more complex types than previous reports had. Because we dissect the lymph nodes according to the type of blood supply, knowing the type before splenic flexure surgery is crucial.
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Affiliation(s)
- Asako Fukuoka
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Takahiro Sasaki
- Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Satoshi Tsukikawa
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nobuyoshi Miyajima
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takehito Ostubo
- Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
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Watanabe J, Ota M, Suwa Y, Ishibe A, Masui H, Nagahori K. Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging. Int J Colorectal Dis 2017; 32:201-207. [PMID: 27695977 DOI: 10.1007/s00384-016-2669-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The treatment of splenic flexural colon cancer is not standardized because the lymphatic drainage is variable. The aim of this study is to evaluate the lymph flow at the splenic flexure. METHODS From July 2013 to January 2016, consecutive patients of the splenic flexural colon cancer with a preoperative diagnosis of N0 who underwent laparoscopic surgery were enrolled. Primary outcome is frequency of the direction of lymph flow from splenic flexure. We injected indocyanine green (2.5 mg) into the submucosal layer around the tumor and observed lymph flow using the laparoscopic near-infrared camera system in 30 min after injection. RESULTS Thirty-one patients were enrolled in this study. The lymph flow was visualized in 31 patients (100 %) without any complications. No case exhibited lymph flow in both the left colic artery (LCA) and left branch of the middle colic artery (lt-MCA) areas. There were 19 cases (61.3 %) with lymph flow directed to the area of the root of the inferior mesenteric vein (IMV), regardless of the presence of the left accessory aberrant colic artery. Lymph node metastases were observed in six cases (19.4 %), and all of the involved lymph nodes existed in lymph flow areas determined by real-time indocyanine green fluorescence imaging. CONCLUSIONS The findings of the lymph flow pattern of splenic flexure suggest that lymph node dissection at the root of the IMV area is important, and it may be not necessary to ligate both the lt-MCA and LCA, at least in cases without widespread lymph node metastases.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan.
| | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Yusuke Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Hidenobu Masui
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan
| | - Kaoru Nagahori
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan
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