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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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Tei M, Suzuki Y, Sueda T, Iwamoto K, Naito A, Nomura M, Yoshikawa Y, Ohtsuka M, Imasato M, Mizushima T, Akamatsu H. Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for descending colon cancer: a propensity score-matched analysis. BMC Gastroenterol 2022; 22:511. [PMID: 36494780 PMCID: PMC9738018 DOI: 10.1186/s12876-022-02597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The clinical impact of single-incision laparoscopic surgery (SILS) for descending colon cancer (DCC) is unclear. The aim of this study was to evaluate the clinical outcomes of SILS for DCC compared with multi-port laparoscopic surgery (MPLS). METHODS We retrospectively analyzed 137 consecutive patients with stage I-III DCC who underwent SILS or MPLS at two high-volume multidisciplinary tertiary hospitals between April 2008 and December 2018, using propensity score-matched analysis. RESULTS After propensity score-matching, we enrolled 88 patients (n = 44 in each group). SILS was successful in 97.7% of the matched cohort. Compared with the MPLS group, the SILS group showed significantly less blood loss and a greater number of harvested lymph nodes. Morbidity rates were similar between groups. Recurrence pattern did not differ between groups. No significant differences were found between groups in terms of 3-year disease-free and overall survivals. CONCLUSION SILS appears safe and feasible and can provide satisfactory oncological outcomes for patients with DCC.
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Affiliation(s)
- Mitsuyoshi Tei
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Yozo Suzuki
- grid.417245.10000 0004 1774 8664Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Toshinori Sueda
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Kazuya Iwamoto
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Atsushi Naito
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masatoshi Nomura
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Yukihiro Yoshikawa
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Masahisa Ohtsuka
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Mitsunobu Imasato
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
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Struys M, Ceelen W. Incidence of lymph node recurrence after primary surgery for non-metastatic colon cancer: A systematic review. Eur J Surg Oncol 2022; 48:1679-1684. [DOI: 10.1016/j.ejso.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022] Open
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Tei M, Suzuki Y, Ohtsuka M, Mizushima T, Akamatsu H. Single-Incision Laparoscopic Complete Mesocolic Excision With Central Vascular Ligation for Descending Colon Cancer. Am Surg 2022:31348211068009. [DOI: 10.1177/00031348211068009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Single-incision laparoscopic complete mesocolic excision with central vascular ligation for descending colon cancer is technically challenging. Standardization of the surgical procedures is therefore needed. Methods In a Trendelenburg position with left side elevated, the sigmoid mesocolon is mobilized using a medial-to-lateral approach, and the left colic artery and inferior mesenteric vein (IMV) are divided after radical lymphadenectomy along the inferior mesenteric artery, preserving the superior rectal artery. The descending mesocolon is mobilized from the retroperitoneal planes up to the dorsal surface of the pancreas using medial and lateral approaches. Next, changing the surgical position to a reverse Trendelenburg position with left side elevated, the omental bursa is opened, and the transverse mesocolon is separated from the inferior border of the pancreas. The splenocolic ligament and lateral attachment are then divided, matching the previous medial dissection of the retroperitoneum, and the splenic flexure is fully mobilized. The IMV is divided again at the inferior border of the pancreas. The left branch of the middle colic artery is also divided. Results Forty-seven consecutive patients with DCC underwent single-incision laparoscopic CME with CVL. One patient required an additional port. Median operative time, blood loss, and number of harvested lymph nodes were 240 min (interquartile range [IQR], 195-257 min), 5 mL (IQR, 5-52 mL), and 21 (IQR, 13-29), respectively. Morbidity rate was 5.9%. Median duration of hospitalization was 9 days (IQR, 7-11 days). Conclusions Single-incision laparoscopic CME with CVL is safe and feasible for DCC.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
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