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Surgical management of splenic flexure colon cancer: a retrospective propensity-matched study comparing open and minimally invasive approaches using the national cancer database

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Minimally invasive resection of colon cancer at the splenic flexure can be technically challenging with concerns for a suboptimal oncologic outcome. We aimed to compare open and minimally invasive approaches following curative resection.

Methods

The National Cancer Database was queried for patients with non-metastatic colon adenocarcinoma at the splenic flexure who underwent resection from 2010 to 2016. Cohorts were separated into open and minimally invasive approaches, and demographic and clinicopathologic variables were compared. Propensity-score matching (PSM) was utilized to balance potential confounding covariates between cohorts to elucidate the independent association between surgical approach and outcomes. Kaplan–Meier estimation and Cox-proportional hazards regression were used to analyze survival. Secondary outcomes were analyzed by way of logistic regression or Mann–Whitney U test.

Results

After matching, 842 patients were compared between approaches. Patients who underwent minimally invasive surgery had no significant difference in regional nodes ≥ 12 examined, positive margins, negative circumferential margins, unplanned 30-day readmission, or time from surgery to initiation of chemotherapy when compared to patients who underwent open surgery. Minimally invasive surgery was significantly associated with decreased odds of 30-day mortality, 90-day mortality, and decreased mortality hazard for 5-year overall survival compared to open surgery.

Conclusion

The optimal approach for surgical management of splenic flexure colon cancer has not been standardized given its rarity and exclusion from randomized controlled trials. Our retrospective review suggests that minimally invasive resection of splenic flexure colon cancers in carefully selected patients is associated with equivalent oncologic outcomes as well as improved short and long-term survival compared to an open approach.

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Data is available upon reasonable request.

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Author information

Authors and Affiliations

  1. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Michael L. Horsey

  2. Department of Surgery, George Washington University Medical Faculty Associates, Washington, DC, USA

    Andrew D. Sparks

  3. Department of Surgery, George Washington University Hospital, Washington, DC, USA

    Debra Lai

  4. George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Aalap Herur-Raman

  5. Department of Colon and Rectal Surgery, George Washington University Hospital, Washington, DC, USA

    Matthew Ng & Vincent Obias

Authors
  1. Michael L. Horsey
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  2. Andrew D. Sparks
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  3. Debra Lai
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  4. Aalap Herur-Raman
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  5. Matthew Ng
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  6. Vincent Obias
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Corresponding author

Correspondence to Michael L. Horsey.

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Ethics approval

This study was deemed exempt by the George Washington University Institutional Review Board.

Conflict of interest

Dr. Michael Horsey, Mr. Andrew Sparks, Dr. Debra Lai, Mr. Aalap Herur-Raman, and Dr. Matthew Ng have no conflicts of interest or financial ties to disclose. Dr. Vincent Obias is a consultant for Medrobotics.

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Horsey, M.L., Sparks, A.D., Lai, D. et al. Surgical management of splenic flexure colon cancer: a retrospective propensity-matched study comparing open and minimally invasive approaches using the national cancer database. Int J Colorectal Dis 36, 2739–2747 (2021). https://doi.org/10.1007/s00384-021-04029-y

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  • DOI: https://doi.org/10.1007/s00384-021-04029-y

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