Carcinoma of the splenic flexure

Khafagy, Medhat; Stearns, Maus W.

doi:10.1007/bf02588878

Cited by 19 publications

(12 citation statements)

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“…1,4 An additional rationale for extended surgery is that the splenic flexure has direct lymphatic drainage to the splenic hilum and along the pancreatic tail, 5 however, whether this extended surgery improves the prognosis of patients with splenic flexure cancer remains controversial. [1][2][3][4]6 This study reviews our experience of treating carcinoma at this site and discusses the problems associated with appropriate operative procedure selection for splenic flexure cancer.…”

Section: Introductionmentioning

confidence: 98%

Surgical Treatment and Subsequent Outcome of Patients with Carcinoma of the Splenic Flexure

et al. 2001

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Extended resection, comprising extended right hemicolectomy, splenectomy, and distal pancreatectomy, has been advocated for carcinoma of the splenic flexure because the lymphatic drainage at this site is variable. The present study addresses the problems associated with selecting the most appropriate operative procedure to achieve cure of splenic flexure cancers. We conducted a retrospective review of 27 patients with splenic flexure cancer who underwent curative resection. Left partial colectomy was performed in 20 patients and partial resection of the transverse/descending colon was performed in 7 patients. The combined resection of adjacent organs due to tumor adherence was performed in three patients. The spleen and distal pancreas were the organs most frequently resected among a collective total of six adjacent organs. The median duration of follow-up was 60.9 months after resection for splenic flexure cancer. No patient developed local recurrence. There was no significant difference in 5-year survival between patients with splenic flexure cancers and those with colon cancers at other sites. In conclusion, splenic flexure cancer resected by left partial colectomy or partial resection of the transverse/descending colon without routine extended resection was not associated with a worse prognosis than colon cancers at other sites.

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Section: Introductionmentioning

confidence: 98%

Surgical Treatment and Subsequent Outcome of Patients with Carcinoma of the Splenic Flexure

et al. 2001

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“…[2][3][4]7 However, whether such extended surgery is really necessary to improve the outcome in splenic flexure cancer is controversial. [2][3][4][5]7 Thus, the clinicopathological characteristics, management, and outcome of splenic flexure cancer have yet to be fully elucidated. [2][3][4][5][6][7][8] To date, there has been a small number of reports discussing splenic flexure cancer, but the clinical and pathological data in these reports were evaluated only by univariate analysis.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5]7 Thus, the clinicopathological characteristics, management, and outcome of splenic flexure cancer have yet to be fully elucidated. [2][3][4][5][6][7][8] To date, there has been a small number of reports discussing splenic flexure cancer, but the clinical and pathological data in these reports were evaluated only by univariate analysis. We are of the opinion that the univariate-analyzed data should be verified by multivariate analysis.…”

Section: Introductionmentioning

confidence: 99%

“…1 However, despite the large number of patients available for study, insufficient data have been available to make a definitive statement on the effect of a simple variable, such as tumor site, especially splenic flexure, on outcome after surgery. 2 To date, it has been established that carcinoma of the splenic flexure is uncommon, [2][3][4][5][6] and is associated with a high risk of obstruction. 2,3 However, survival after resection of splenic flexure cancers is controversial.…”

Section: Introductionmentioning

confidence: 99%

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Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery

Nakagoe

Sawai

Tsuji

et al. 2000

Journal of Gastroenterology

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The clinicopathological characteristics and outcome of splenic flexure cancer after surgery have yet to be fully elucidated. The aim of the current study was, therefore, to establish predictive factors related to splenic flexure cancer and outcome after surgery. We compared the clinicopathological characteristics and outcome of 34 patients with splenic flexure cancers (which represents 3.7% of the total number of colon cancers in our series) with those of 418 patients with right colon and 475 patients with left colon cancers by univariate and multivariate analyses, using logistic regression analysis and Cox's proportional hazards model. Splenic flexure cancers had a high risk of obstruction (26.5% of patients), and had a more advanced stage and lower cure rate than left colon cancers. Logistic regression analysis revealed that two independent factors, colonic obstruction and the presence of distant metastases, were related to the splenic flexure tumor site. Splenic flexure cancer patients had a poorer outcome than those with left colon cancer (P = 0.0361). However, there was no difference in survival between patients with splenic flexure, those with right colon cancer and those with left colon cancer who underwent curative surgery. Cox's regression analysis revealed that neither the site of splenic flexure nor colonic obstruction was an independent prognostic factor. In conclusion, splenic flexure cancer is characterized by a high risk of obstruction and the presence of distant metastases. However, after curative resection, splenic flexure cancer has a similar outcome to colon cancer at other sites. In addition, neither the splenic flexure site nor colonic obstruction had an independent influence on patient survival after surgery.

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“…The concept of high vessel ligation is to include resection of the paracolic nodes, intermediate nodes and apical lymphnodes, which defined as D3 lymph-adenectomy. D3 lymph-adenectomy have been widely used and accepted in Japan, China and Korea [10][11][12]. In case of SFC, whether high level of vessel ligation is required to include LMC artery or not, yet has not been proposed.…”

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confidence: 99%

Optimum Level of Vessel Ligation in Splenic Flexure Cancer

Bandar¹,

Han²,

Sabilah³

et al. 2016

J Surg Surgical Res

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.17, respectively. Recurrence rate found relatively greater in LCA plus MMC group compared to of LCA plus LMA but haven't reached statistical significant, 16.6% vs. 10.52%, p=0.56, respectively. 5-year disease-free survival and overall survival rate were similar in both groups. Conclusion:Higher level of vessel ligation has not add significant different in overall outcome, however, has a potential role to lower the risk of recurrence rate in SFC patients.enhanced overall survival up to 15.6% when dissection take place in embryological planes. Moreover, central venous ligation and division of feeding vessel at the root have shown a successful concept to retrieved higher number of lymph node metastasis [8]. On top of that, higher number of lymph node harvested attributed in accurate staging [9]. CME principles for right-sided resection equivalent to the current TME principles for left sided resection. Therefore, optimal vessel ligation has been discussed and studied well in the right-sided colon cancer with anticipated success to achieve oncological benefits. However, guideline to determine the level of vessel ligation in SPC is still remained in debates. The concept of high vessel ligation is to include resection of the paracolic nodes, intermediate nodes and apical lymphnodes, which defined as D3 lymph-adenectomy. D3 lymph-adenectomy have been widely used and accepted in Japan, China and Korea [10][11][12]. In case of SFC, whether high level of vessel ligation is required to include LMC artery or not, yet has not been proposed. To our knowledge, this is the first study aiming to investigate the adequacy of vessel ligation in SFC in term of overall survival (OS) and local recurrence. Materials and Methods Patients

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Carcinoma of the splenic flexure

Cited by 19 publications

References 1 publication

Surgical Treatment and Subsequent Outcome of Patients with Carcinoma of the Splenic Flexure

Surgical Treatment and Subsequent Outcome of Patients with Carcinoma of the Splenic Flexure

Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery

Optimum Level of Vessel Ligation in Splenic Flexure Cancer

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