The CT scan was integrated to a virtual colonoscopy in cases of incomplete endoscopic exam. The routine preoperative evaluations included physical examination, serum carcinoembryonic antigen (CEA), colonoscopy with biopsy, whole body computed tomography (CT). In order to improve the knowledge about the outcome of different procedures, we have compared the results of three different approaches (extended right hemicolectomy, extended left hemicolectomy and segmental resection) to splenic flexure cancer, examining the pathologic and oncologic outcomes in patients operated with curative intent in our Institution and prospectively included into a dedicated colorectal cancer database. Moreover only the 14% of surgeons seem to perform segmental resection for splenic flexure cancer 6, 9, 10, 11. At the best of our knowledge, only few studies investigated a segmental splenic flexure resection compared to extended colectomy, with the goal of proving the oncological equivalence between these two approaches. To date, several authors have evaluated the differences between laparoscopic and open approach, or have compared intracorporeal versus extracorporeal anastomosis 7, 8. As matter of fact, the challenge is related to the peculiar dual lymphatic drainage of the superior and inferior mesenteric vessels, which lie between the right and left territories 3, 5, 6. Other factors contribute to the prognosis namely histological grade of differentiation, presence of lymphovascular and perineural invasion, the quality of the specimen with complete mesocolic excision (CME), the presence of perforation or intestinal obstruction at the time of diagnosis.Ī standard surgical approach to splenic flexure cancer has not been described and various extent of resections have been advocated, going from extended colectomy to segmental resection, with or without adjacent organ resections (i.e. Pathologic stage currently remains the main prognostic factor, although it cannot fully predict the clinical outcome by itself. The diagnosis of this cancer is often late, in an advanced stage of illness, mainly with an obstructive clinical presentation 4. It is relatively rare and represent only 1–8% of all colon cancers 2, 3. Splenic flexure cancer (SFC) is defined as a colon cancer situated in the distal third of the transverse colon, or in the left colonic corner, or in the proximal descending colon within 10 cm from the flexure 1. It is our opinion that the extended surgery is seldomly indicated to cure splenic flexure cancer. 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.
INTESTINAL FLEXTURE FREE
There was no difference in overall and progression free survival among the three different surgical treatments. After a median follow-up of 42 months, 30 recurrences and 19 deaths occurred (12 for tumor progression).
In all groups no differences were found in the total number of harvested lymphnodes. No significant differences in complications were found among the three groups. The tumor infiltrated near organs (T4) in 5 patients. 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. We evaluated the clinicopathological findings and outcomes of all patients and associated them to the different surgical treatment. Between January 2006 and May 2016, 103 patients with splenic flexure colon cancer were enrolled in the study. 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.
It also marks the small bowel's transition from the retroperitoneum, which invests the duodenum, into the peritoneal cavity.Extended right or left hemicolectomy are the most common surgical treatments for splenic flexure colon cancer. The duodenojejunal flexure is suspended from the ligament of Treitz, which serves as its surgical landmark and gives it its unique shape. The duodenojejunal flexure is located anterolateral to the aorta at the level of the upper border of the second lumbar vertebra. It makes a sharp turn anteroinferiorly to become the jejunum.
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