Extended right hemicolectomy and left hemicolectomy for colorectal cancers between the distal transverse and proximal descending colon

Gravante, Gianpiero; Elshaer, Mohamed; Parker, R; Mogekwu, AC; Drake, Benjamin; Aboelkassem, A; Rahman, EU; Sorge, Roberto; Alhammali, Tariq; Gardiner, Katy; Al-Hamali, Salem; Rashed, Mohamed; Kelkar, Ashish; Agarwal, Roshan; El-Rabaa, Saleem

doi:10.1308/rcsann.2016.0112

Cited by 34 publications

(55 citation statements)

References 21 publications

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“…In our series the mean time for recovery of flatus and passage of stool was significantly faster after LCR, leading to a significantly longer postoperative hospital stay after ERH. However, the overall incidence of postoperative complications and the need for reoperation did not show any significant difference on multivariate analysis as previously reported by other authors .…”

Section: Discussionsupporting

confidence: 86%

“…It was advocated that the subsequent risk of accidental splenectomy is higher in splenic flexure tumours, thus leading to higher postoperative morbidity and mortality . In our series no unplanned splenectomy was required and 30‐day mortality was comparable to other studies without significant differences between ERH and LCR . Likewise, Beisani et al .…”

Section: Discussionsupporting

confidence: 73%

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

et al. 2019

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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.Keywords Colon cancer, splenic flexure, surgery, extended right hemicolectomy, left colon resection, surgeon's specialty What does this paper add to the literature? This is the largest series analysing the surgical treatment of splenic flexure cancer comparing the short-term outcomes of two different surgical techniques performed by two different types of surgeons: general surgeons and colorectal surgeons.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 73%

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

et al. 2019

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“…In the searched literature, almost all studies about splenic flexure cancer surgery compare the right extended colon resection versus the left extended colon resection, with poor data concerning the long-term oncological outcomes 25,32,33 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center

Rega

Pace

Scala

et al. 2019

Sci Rep

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Extended right or left hemicolectomy are the most common surgical treatments for splenic flexure colon cancer. Extended resection (including distal pancreasectomy and/or splenectomy), has been often indicated for the treatment for the splenic flexure cancer, because the lymphatic drainage at this site is poorly defined and assumed as heterogeneous. Between January 2006 and May 2016, 103 patients with splenic flexure colon cancer were enrolled in the study. We evaluated the clinicopathological findings and outcomes of all patients and associated them to the different surgical treatment. Out of 103 selected cases an extended right hemicolectomy was performed in 22 (21.4%) patients, an extended left hemicolectomy in 24 (23.3%) patients, a segmental resection of the splenic flexure in 57 (55.3%) patients; the combined resection of adjacent organs showing tumor adherence was carried out in 11 (10.7%) patients. The tumor infiltrated near organs (T4) in 5 patients. No significant differences in complications were found among the three groups. In all groups no differences were found in the total number of harvested lymphnodes. After a median follow-up of 42 months, 30 recurrences and 19 deaths occurred (12 for tumor progression). There was no difference in overall and progression free survival among the three different surgical treatments. According to our results, the partial resection of splenic flexure was not associated with a worse prognosis and it was leading for a satisfactory oncological outcome. It is our opinion that the extended surgery is seldomly indicated to cure splenic flexure cancer.

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“…Gravante 2016 [13] Martin Arevalo 2018 [11] Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2020 [ Test for overall effect: Z = 0.89 (P = 0.37) Heterogeneity: Chi 2 = 3.15, df = 4 (P = 0.53); I 2 = 0% Test for overall effect: Z = 0.59 (P = 0.56) Heterogeneity: Tau 2 = 519.85; Chi 2 = 19.68, df = 4 (P = 0.0006); I 2 = 80% Gravante 2016 [13] Martin Arevalo 2018 [11] Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2020 [ [14] de' Angelis 2016 [12] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] Rega 2019 [16] Rega 2019 [16] Rega 2019 [16] Rega 2019 [16] Total ( Odermatt 2014 [14] Odermatt 2014 [14] Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] Gravante Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [ Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] Rega Gravante 2016 …”

Section: Extended Right Hemicolectomy Versus Segmental Colectomymentioning

confidence: 99%

Comparison of extended right hemicolectomy, left hemicolectomy and segmental colectomy for splenic flexure colon cancer: a systematic review and meta‐analysis

et al. 2020

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Aim The aim of this work was to compare the outcomes of extended right hemicolectomy (ERH), left hemicolectomy (LH) and segmental colectomy (SC) for the surgical management of splenic flexure tumours. Method In compliance with PRISMA statement standards, a systematic review was performed to identify all studies comparing outcomes of ERH, LH and SC for the surgical management of splenic flexure tumours. Primary outcomes included anastomotic leakage and all postoperative complications. The secondary outcomes included operative time, R0 resection, number of harvested lymph nodes, > 12 harvested lymph nodes, severe complications, postoperative mortality, paralytic ileus, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, 5year overall survival and 5-year disease-free survival. The ROBINS-I tool and GRADE system were used to assess the risk of bias and certainty of evidence, respectively. Results Analysis of 956 patients from seven observational studies showed that ERH was associated with more paralytic ileus than LH (OR 2.74, P = 0.002) and SC (OR 6.67, P < 0.0001) and the operative time was shorter in SC than in ERH (mean difference 25.48, P < 0.0001) and LH (mean difference À17.94, P = 0.0002). There were no differences between ERH, LH and SC in terms of anastomotic leakage, postoperative complications, R0 resection, severe complications, postoperative mortality, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, > 12 harvested lymph nodes, 5-year overall survival and 5-year disease-free survival. Conclusions The available evidence, limited to observational studies, suggests that there is no difference between ERH, LH and SC in terms of postoperative morbidity and mortality, lymph node yield and cancer survival. Randomized controlled trials are required for definite conclusions.

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Extended right hemicolectomy and left hemicolectomy for colorectal cancers between the distal transverse and proximal descending colon

Abstract: In our experience, both ERH and LH are adequate for tumours located between the distal transverse and the proximal descending colon.

Cited by 34 publications

References 21 publications

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

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

Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center

Comparison of extended right hemicolectomy, left hemicolectomy and segmental colectomy for splenic flexure colon cancer: a systematic review and meta‐analysis

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