Laparoscopic segmental left colectomy for splenic flexure carcinoma: a single institution experience.
Laparoscopy
Morbidity
Oncologic results
Segmental left colectomy
Splenic flexure colon cancer
Subtotal colectomy
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
27
01
2019
accepted:
21
11
2019
pubmed:
14
12
2019
medline:
13
3
2021
entrez:
14
12
2019
Statut:
ppublish
Résumé
There is ongoing debate regarding surgical treatment of splenic flexure cancer. The main points of controversy include the appropriate extent of colon resection, either to the right or to the left, and the appropriate extent of lymph-node dissection. The aim of this study was to review our experience in laparoscopic treatment of splenic flexure cancer cases and to compare our data to the recent literature. Consecutive patients, operated on for splenic flexure colon carcinoma at a single institution between April 2005 and January 2013, were included in the study. Exclusion criteria were a previous history of colorectal cancer, recurrent colonic cancer, emergency cases with an obstructive tumor or a perforated tumor with peritonitis, synchronous cancer, palliative surgery, and a past history of colorectal resection. Patients underwent laparoscopic segmental left colectomy with ligation of the left branch of the middle colic and of the left colic artery. Patient characteristics, operative and postoperative outcomes, and long-term technical, functional, and oncological results from a prospectively maintained database were retrospectively analyzed. After hospital discharge, standardized follow-up was performed at 1 month postoperatively, then every 3 months during the first 2 years, and every 6 months thereafter, for a total of 5 years. A total of 28 consecutive patients (16 males) with a median age of 71.8 years (range 42.5-88.8 years) were included. Ninety-day mortality was 3.5% and surgical morbidity was 21.5% with anastomotic leak rate of 10.7%. All survivors experienced good or very good functional results. During a median follow-up period of 50.9 months, eight patients (28.5%) presented with a recurrence. The 5-year overall and disease-free survival rates were 46.3% and 39.2%, respectively. Segmental left colectomy for splenic flexure carcinoma is associated with reasonably low morbidity and very good functional results. However, survival rates are low.
Sections du résumé
BACKGROUND
There is ongoing debate regarding surgical treatment of splenic flexure cancer. The main points of controversy include the appropriate extent of colon resection, either to the right or to the left, and the appropriate extent of lymph-node dissection. The aim of this study was to review our experience in laparoscopic treatment of splenic flexure cancer cases and to compare our data to the recent literature.
METHODS
Consecutive patients, operated on for splenic flexure colon carcinoma at a single institution between April 2005 and January 2013, were included in the study. Exclusion criteria were a previous history of colorectal cancer, recurrent colonic cancer, emergency cases with an obstructive tumor or a perforated tumor with peritonitis, synchronous cancer, palliative surgery, and a past history of colorectal resection. Patients underwent laparoscopic segmental left colectomy with ligation of the left branch of the middle colic and of the left colic artery. Patient characteristics, operative and postoperative outcomes, and long-term technical, functional, and oncological results from a prospectively maintained database were retrospectively analyzed. After hospital discharge, standardized follow-up was performed at 1 month postoperatively, then every 3 months during the first 2 years, and every 6 months thereafter, for a total of 5 years.
RESULTS
A total of 28 consecutive patients (16 males) with a median age of 71.8 years (range 42.5-88.8 years) were included. Ninety-day mortality was 3.5% and surgical morbidity was 21.5% with anastomotic leak rate of 10.7%. All survivors experienced good or very good functional results. During a median follow-up period of 50.9 months, eight patients (28.5%) presented with a recurrence. The 5-year overall and disease-free survival rates were 46.3% and 39.2%, respectively.
CONCLUSIONS
Segmental left colectomy for splenic flexure carcinoma is associated with reasonably low morbidity and very good functional results. However, survival rates are low.
Identifiants
pubmed: 31834555
doi: 10.1007/s10151-019-02126-3
pii: 10.1007/s10151-019-02126-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
41-48Références
Dis Colon Rectum. 1994 Jul;37(7):651-9
pubmed: 8026230
J Vis Surg. 2016 Aug 31;2:148
pubmed: 29078535
Am J Surg. 2018 Aug;216(2):251-254
pubmed: 28709626
Br J Surg. 1986 Aug;73(8):663-70
pubmed: 3742184
Hepatogastroenterology. 2007 Mar;54(74):422-6
pubmed: 17523288
Surg Endosc. 2010 Nov;24(11):2749-54
pubmed: 20383534
Arch Surg. 2008 Aug;143(8):762-7; discussion 768
pubmed: 18711036
Surg Today. 2014 Nov;44(11):2045-51
pubmed: 24306213
J Surg Oncol. 2016 Aug;114(2):228-36
pubmed: 27158137
Surg Laparosc Endosc Percutan Tech. 2011 Dec;21(6):415-8
pubmed: 22146163
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
BMC Gastroenterol. 2015 Jul 07;15:76
pubmed: 26148781
Int J Colorectal Dis. 2014 Oct;29(10):1223-9
pubmed: 25060216
Dis Colon Rectum. 2008 Jul;51(7):1036-43
pubmed: 18470560
Dis Colon Rectum. 1991 May;34(5):401-3
pubmed: 2022146
Surg Laparosc Endosc Percutan Tech. 2017 Oct;27(5):318-327
pubmed: 28796653
Tech Coloproctol. 2018 Apr;22(4):271-277
pubmed: 29551004
Cancer Res Treat. 2010 Jun;42(2):69-76
pubmed: 20622960
Colorectal Dis. 2013 Sep;15(9):1078-85
pubmed: 23570604
Int J Colorectal Dis. 2016 Mar;31(3):623-30
pubmed: 26689401
Updates Surg. 2016 Mar;68(1):71-5
pubmed: 27015933
Dis Colon Rectum. 2016 Dec;59(12):1209-1221
pubmed: 27824707
J Gastroenterol. 2000;35(7):528-35
pubmed: 10905361
Lancet. 2009 Sep 26;374(9695):1105-12
pubmed: 19782876
Dis Colon Rectum. 1987 Nov;30(11):872-4
pubmed: 3677963
Postgrad Med J. 1992 Jun;68(800):487
pubmed: 1437940
Asian J Endosc Surg. 2017 May;10(2):148-153
pubmed: 28008722