Carcinoma of the splenic flexure: what surgical treatment

D. Rega, U. Pace, A. Niglio, D. Scala, C. Sassaroli, F. Ruffolo, M. Pannullo, P. Delrio

Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione Giovanni Pascale" IRCCS - Naples, Italy Colorectal Surgical Oncology - Chief: Paolo Delrio

Conclusion The objective of surgical treatment for resectable carcinoma of the colon is to remove the growth with an adequate margin by performing a wide excision of the tumor and associated lymphatics, paying careful attention to the blood supply. A rationale for extended surgery is that the splenic flexure has direct lymphatic drainage to the splenic hilum and along the pancreatic. It is our opinion that extended surgery is unnecessary to cure splenic flexure. Our results show that partial resection of splenic flexure was not associated with a worse prognosis and it was sufficient for a satisfactory oncological outcome.

Methods We compared the clinicopathological characteristics and outcome of 79 patients with splenic flexure colon cancer, between february 2003 to march 2016. Of the total 79 patients, 47 were males and 32 females, ranging in age from 37 to 86 years, with a mean age of 66. Colonic substenosis was present in 29 patients; in 4 patients the tumor infiltrated near organs (T4).

Results There was no difference in survival and disease-free between the different surgical treatments. The difference in survival and disease-free was related exclusively to pathologic stage (pTNM).

Extended left hemicolectomy Partial resection of the transverse colon

Extended right hemicolectomy

Surgical procedures Partial resection of the transverse colon

Extended right hemicolectomy

Extended left hemicolectomy

Combined resection of adjacent organs

- with partial resection of the splenic flexure

41 (53,3%)

9 (11,7%)

10 (13%)

17 (22%)

- 12

Follow up Median 49 months (range 6 - 162)

DistantrecurrenceLocalrecurrenceExitusforprogressiondisease

7pts1pt4

Patients Male Female

79 47 (59%) 32 (41%)

Age Mean

66 years (range 37 – 86)

Histophatologic Stage

0

I

IIA

IIC

IIIA

IIIB

IIIC

IVA

12 pts (15%)

20 pts (25%)

19 pts (24%)

1 pts (1%)

2 pt (3%)

17 pts (21%)

6 pts (8%)

2 pts (3%)

Background Extended right hemicolectomy or extended left hemicolectomy are the most common surgical treatments for carcinoma of the splenic flexure. Extended resection, comprising splenectomy and/or distal pancreasectomy, has been advocated for treatment for carcinoma of the splenic flexure because the lymphatic drainage at this site is variable. This study examined the clinicopathologic characteristics of patients with splenic flexure colon cancer and the association with surgical outcomes to find the most appropriate operative procedure to achieve cure of splenic flexure cancers.