Surgical Treatment Of Splenic Flexure Cancer: Analysis Of Short-term And Long-term Outcomes Of Three Different Surgical Procedures

Purpose: 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 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.Categorical variables were analysed using the Chi-squared or Fisher’s exact test.ANOVA or the nonparametric Kruskal-Wallis test for continuous variables depending on their distribution.The survival analyses were performed using the Kaplan-Meier method and log-rank tests.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.The duration of the operation was significantly longer for the SFC procedure(P=0.003).When analyzing the development of each complication,no differences were demonstrated among the groups.No reoperation or mortality were observed.R0 resections were achieved in all patients.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%).There was no difference among the groups regarding the number of metastatic lymph nodes removed.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%).Dissection with or without removal of the lymph nodes at the root of the IMA or the gastroepiploic lymph nodes showed similar outcomes in terms of DFS and OS.Conclusion: Splenic flexure cancer has a favorable prognosis.The rate of metastatic lymph nodes at the root of the central artery and gastroepiploic arcade node was relatively low.SFC is a safe and effective treatment option for splenic flexure cancer.