Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis

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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Acknowledgements

The authors would like to thank Dr Clotilde Carra for her valuable support in manuscript revisions. SFC Study Group collaborators who participated in the study providing cares for the study patients and collecting the data: Giorgio Bianchi, Julie Pham, Pietro Genova, Iradj Sobhani (Unit of Digestive, Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France). Segundo A. Gómez, M. Teresa Torres, Carmen Payá, Paula Gonzálvez (Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain). Aine Stakelum, Alexandra Zaborowski (Department of Surgery, St. Vincent’s Hospital, Elm Park, Dublin 4, Ireland). Albert Sueiras-Gil, Ramiro Hevia (Department of General Surgery, Viladecans Hospital, Barcelona, Spain). Michela Assalino (Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland). Denis Pezet, Mourad Abdallah (Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, France). Luca Ansaloni (General, Emergency and Trauma Surgery Department, Bufalini Hospital of Cesena, Italy), Arianna Birindelli (Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Cambridge, UK), Christine Denet (Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris France), Alejandro Solis, Miquel Kraft (Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Barcelona, Universitat Autonoma de Barcelona, Spain).

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Correspondence to Nicola de’Angelis.

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Drs Nicola de’Angelis, Aleix Martínez-Pérez, Des C. Winter, Filippo Landi, Giulio C. Vitali, Bertrand Le Roy, Federico Coccolini, Francesco Brunetti, Valerio Celentano, Salomone Di Saverio, Frederic Ris, David Fuks, and Eloy Espin have no conflicts of interest or financial ties to disclose.

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The SFC Study Group collaborators who participated in the study providing cares for the study patients and collecting the data has been included in ‘Acknowledgements’ section.

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de’Angelis, N., Martínez-Pérez, A., Winter, D.C. et al. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc 35, 661–672 (2021). https://doi.org/10.1007/s00464-020-07431-9

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Keywords

  • Splenic flexure carcinoma
  • Extended right colectomy
  • Left colectomy
  • Segmental left colectomy
  • Propensity score matching
  • Postoperative complications