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

G. A. Binda, A. Amato, G. Alberton, M. Bruzzone, P. Secondo, J. Lòpez-Borao, R. Giudicissi, A. Falato, C. Fucini, F. Bianco, S. Biondo

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalColorectal Disease
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Transverse Colon
Colonic Neoplasms
Colic
Splenic Neoplasms
Reoperation
Emergencies
Therapeutics
Morbidity
Multicenter Studies
Habits
Surgeons
Multivariate Analysis
Smoking
Mortality
Neoplasms

Keywords

  • Colon cancer
  • extended right hemicolectomy
  • left colon resection
  • splenic flexure
  • surgeon\x92s specialty
  • surgery

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Binda, G. A., Amato, A., Alberton, G., Bruzzone, M., Secondo, P., Lòpez-Borao, J., ... Biondo, S. (Accepted/In press). Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short-term outcomes. Colorectal Disease. https://doi.org/10.1111/codi.14832

Surgical treatment of a colon neoplasm of the splenic flexure : a multicentric study of short-term outcomes. / Binda, G. A.; Amato, A.; Alberton, G.; Bruzzone, M.; Secondo, P.; Lòpez-Borao, J.; Giudicissi, R.; Falato, A.; Fucini, C.; Bianco, F.; Biondo, S.

In: Colorectal Disease, 01.01.2019.

Research output: Contribution to journalArticle

Binda, GA, Amato, A, Alberton, G, Bruzzone, M, Secondo, P, Lòpez-Borao, J, Giudicissi, R, Falato, A, Fucini, C, Bianco, F & Biondo, S 2019, 'Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short-term outcomes', Colorectal Disease. https://doi.org/10.1111/codi.14832
Binda, G. A. ; 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. In: Colorectal Disease. 2019.
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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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AU - Bruzzone, M.

AU - Secondo, P.

AU - Lòpez-Borao, J.

AU - Giudicissi, R.

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