The short- and long-term outcomes for patients with splenic flexure tumours treated by left versus extended right colectomy are comparable: a retrospective analysis

Abstract

Patients undergoing extended right or left colectomy for splenic flexure tumours seemed to have comparable short- and long-term outcomes.

Lymph node metastases in splenic flexure colon cancer: Is subtotal colectomy warranted?

“…Pathological results were judged as satisfactory, with no R1 resection and 87% of the patients with more than 12 LNs harvested during the colonic resection. In our study, subtotal colectomy allowed the evaluation of a significant number of LNs, with a median of 20, which is more important than after left hemicolectomy, with an average between 12 and 20 harvested LNs in published series . After left hemicolectomy, the rate of surgical specimens with less than 12 LNs retrieved can reach up to 40%, which could result in understaging and a worse oncological outcome .…”

“…However, the authors did not exclude patients operated on in emergency, which represented half of the included patients. Furthermore, 10% of patients who underwent left hemicolectomy had a R1 resection, and the rate of local recurrence was 7% . More recently, de’Angelis et al reported a case‐matched study of 54 patients, treated by subtotal colectomy or left hemicolectomy.…”

“…In our study, subtotal colectomy allowed the evaluation of a significant number of LNs, with a median of 20, which is more important than after left hemicolectomy, with an average between 12 and 20 harvested LNs in published series. 10,28,29 After left hemicolectomy, the rate of surgical specimens with less than 12 LNs retrieved can reach up to 40%, which could result in understaging and a worse oncological outcome. 28 Regarding the blood supply of the colon, which determines the lymph node dissection, the vascularization of TSF is subject to anatomical variations in more than a quarter of cases.…”

“…10,28,29 After left hemicolectomy, the rate of surgical specimens with less than 12 LNs retrieved can reach up to 40%, which could result in understaging and a worse oncological outcome. 28 Regarding the blood supply of the colon, which determines the lymph node dissection, the vascularization of TSF is subject to anatomical variations in more than a quarter of cases. Griffiths 30 found in a dissection series of 100 cadavers that the left colic artery was absent in 6% of cases, with a blood supply coming from the MCA.…”

“…As for lymphadenectomy, it is now well established that the number of LNs analysed has an impact on long-term survival after colon cancer surgery, either for stage II or stage III disease 9,[24][25][26][27]. Odermatt et al28 reported a series of 68 non-metastatic patients with TSF, treated by subtotal colectomy or left hemicolectomy. Postoperative outcomes and pathological findings were equivalent between the two groups.At 5 years, overall survival and recurrence-free survival were not different.…”