Colonic splenic flexure carcinoma: is laparoscopic segmental resection a safe enough oncological approach?
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and Other Interventional Techniques
Colonic splenic flexure carcinoma: is laparoscopic segmental resection a safe enough oncological approach? Massimiliano Ardu1 · Carlo Bergamini1 · Jacopo Martellucci1 · Paolo Prosperi1 · Andrea Valeri1 Received: 16 May 2019 / Accepted: 9 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background The surgical approach to the colonic splenic flexure cancer (SFC) is yet to be technically standardized. The aim of this study has been to retrospectively evaluate the oncologic long-term results of our cases comparing our data with other authors’ experiences. Methods Clinical data of patients with SFC operated on at our institute were retrospectively analyzed. The laparoscopic approach was used in the whole series, with limited resection distally and proximally to splenic flexure and the origin ligation of left colic artery and left branch of middle colic artery. Data on the oncological long-term safety were compared to our laparoscopic series of extended right colectomy for proximal two-third transverse colon cancer and high anterior resections for sigmoid-high rectal cancer and to the main evidences in the literature, found after a comprehensive review. Results From March 2008 to May 2018, we completed 53 laparoscopic splenic flexure resections (26 female and 27 male, age 71.5 ± 15.4 years). The conversion rate was 3.8%. Most of the cases were stage II (pT3 73.5%, the mean number of lymph nodes harvested was 19.1, with positivity for malignancy in 45.3%). During the FU (43.5 months), 2 patients dropped out. Out of the 51 residual cases, 37 were alive (72.5%) and 14 are deceased (27.5%). Discussion Compared to the literature, our survival rate does not show significant differences. The other oncological outcomes seem to be comparable with the data evaluated. Conclusions More extended resections seem not to confer an increase of the overall survival rate. Keywords Laparoscopy · Splenic flexure · Colon cancer
Background Colorectal cancer (CRC) is one of the most common gastrointestinal malignancy (the fourth cancer for incidence worldwide), with more than 80% of the left section cancer occurs in the sigmoid. Cancers located between distal transverse and proximal descending colon, usually known as “splenic flexure cancers” (SFC), are on the other hand much less common [1]. According with most of the Authors, the SF is precisely defined as the “junction between the distal third of the transverse colon and the first part of the descending colon within 10 cm from the anatomic flexure” [2]. Due to its rarity, the clinical-pathological features of SFC are poorly defined and surgical treatment is yet to be * Massimiliano Ardu [email protected] 1
Emergency Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
technically standardized. In particular, there are many controversies on the appropriate extent of the colic resection and lymph node dissection; the risk and consequences of
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