Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To compare the outcomes of colonic splenic flexure tumours treated by extended right colectomy versus left colectomy.

Methods

Stage I–III splenic flexure tumours, treated either by extended right colectomy or left colectomy between 1996 and 2011, were identified in a prospective database, and the short- and long-term outcomes compared. The survival analyses were performed using the Kaplan–Meier method and adjusted using a Cox-proportional hazard model.

Results

A total of 30 (44 %) splenic flexure tumours were resected by left colectomy and 38 (56 %) by right colectomy. Emergency operations were more common (74 versus 20 %, p < 0.001) in the right colectomy group. In the univariate analysis, the 5-year overall survival (55 % for right colectomy versus 60 % for left colectomy, p = 0.197) and 5-year recurrence-free survival (41 versus 54 %, p = 0.180, respectively) showed a trend towards a non-significant survival benefit for left colectomy. However, when adjusted for age, gender, ASA classification, tumour stage, urgency and year of surgery, this trend disappeared.

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Levien DH, Gibbons S, Begos D, Byrne DW. Survival after resection of carcinoma of the splenic flexure. Dis Colon Rectum. 1991;34(5):401–3.

    Article  PubMed  CAS  Google Scholar 

  2. Shaikh IA, Suttie SA, Urquhart M, Amin AI, Daniel T, Yalamarthi S. Does the outcome of colonic flexure cancers differ from the other colonic sites? Int J Colorectal Dis. 2012;27(1):89–93.

    Article  PubMed  Google Scholar 

  3. Nakagoe T, Sawa T, Tsuji T, Jibiki M, Nanashima A, Yamaguchi H, et al. Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery. J Gastroenterol. 2000;35(7):528–35.

    Article  PubMed  CAS  Google Scholar 

  4. Bourgouin S, Bege T, Lalonde N, Mancini J, Masson C, Chaumoitre K, et al. Three-dimensional determination of variability in colon anatomy: applications for numerical modeling of the intestine. J Surg Res. 2012;178(1):172–80.

    Article  PubMed  Google Scholar 

  5. Lo Dico R, Lasser P, Goere D, Malka D, Boige V, Pocard M. Lymph road mapping obtained via blue sentinel node detection to avoid middle colic artery resection for highly selected colon cancer cases: proof of a concept? Tech Coloproctol. 2010;14(3):237–40.

    Article  PubMed  CAS  Google Scholar 

  6. de Haas RJ, Wicherts DA, Hobbelink MG, van Diest PJ, Vleggaar FP, Borel Rinkes IH, et al. Sentinel lymph node mapping in colon cancer using radiocolloid as a single tracer: a feasibility study. Nucl Med Commun. 2012;33(8):832–7.

    Article  PubMed  Google Scholar 

  7. Sakorafas GH, Zouros E, Peros G. Applied vascular anatomy of the colon and rectum: clinical implications for the surgical oncologist. Surg Oncol. 2006;15(4):243–55.

    Article  PubMed  Google Scholar 

  8. Balogh A, Wittmann T, Varga L, Zollei I, Lazar G, Baradnay G, et al. Subtotal colectomy for the treatment of obstructive left colon cancer. Follow-up results. Orv Hetil. 2002;143(26):1577–83.

    PubMed  Google Scholar 

  9. Hohenberger W, Reingruber B, Merkel S. Surgery for colon cancer. Scand J Surg. 2003;92(1):45–52.

    PubMed  CAS  Google Scholar 

  10. Benedix F, Schmidt U, Mroczkowski P, Gastinger I, Lippert H, Kube R. Colon carcinoma—classification into right and left sided cancer or according to colonic subsite?—Analysis of 29,568 patients. Eur J Surg Oncol. 2011;37(2):134–9.

    Article  PubMed  CAS  Google Scholar 

  11. Shariff US, Kullar N, Dorudi S. Right colonic transposition technique: when the left colon is unavailable for achieving a pelvic anastomosis. Dis Colon Rectum. 2011;54(3):360–2.

    Article  PubMed  Google Scholar 

  12. Manceau G, Karoui M, Breton S, Blanchet AS, Rousseau G, Savier E, et al. Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes. Dis Colon Rectum. 2012;55(3):363–8.

    Article  PubMed  Google Scholar 

  13. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti AL. AJCC cancer staging manual. New York: Springer; 2009.

    Google Scholar 

  14. Altman DG, De Stavola BL, Love SB, Stepniewska KA. Review of survival analyses published in cancer journals. Br J Cancer. 1995;72(2):511–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Therneau T. A package for survival analysis in S. R package version 2.36-14. 2012.

  16. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org/. 2012.

  17. Nakagoe T, Sawai T, Tsuji T, Jibiki M, Ohbatake M, Nanashima A, et al. Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure. Surg Today. 2001;31(3):204–9.

    Article  PubMed  CAS  Google Scholar 

  18. Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst. 2005;97(3):219–25.

    Article  PubMed  Google Scholar 

  19. Wong SL. Lymph node counts and survival rates after resection for colon and rectal cancer. Gastrointest Cancer Res. 2009;3(2 Suppl):S33–5.

    PubMed  PubMed Central  Google Scholar 

  20. Stocchi L, Fazio VW, Lavery I, Hammel J. Individual surgeon, pathologist, and other factors affecting lymph node harvest in stage II colon carcinoma. Is a minimum of 12 examined lymph nodes sufficient? Ann Surg Oncol. 2011;18(2):405–12.

    Article  PubMed  Google Scholar 

  21. Nedrebo B, Soreide K, Nesbakken A, Eriksen M, Soreide J, Korner H. Risk factors associated with poor lymph node harvest after colon cancer surgery in a national cohort. Colorectal Dis. 2013.

  22. Evans MD, Barton K, Rees A, Stamatakis JD, Karandikar SS. The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease. Colorectal Dis. 2008;10(2):157–64.

    PubMed  CAS  Google Scholar 

  23. Lewis A, Akopian G, Carillo S, Kaufman HS. Lymph node harvest in emergent versus elective colon resections. Am Surg. 2012;78(10):1049–53.

    PubMed  Google Scholar 

  24. Cirocchi R, Farinella E, Trastulli S, Desiderio J, Listorti C, Boselli C, et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013;22(1):14–21.

    Article  PubMed  Google Scholar 

  25. Ceccarelli G, Biancafarina A, Patriti A, Spaziani A, Bartoli A, Bellochi R, et al. Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure. Surg Endosc. 2010;24(7):1784–8.

    Article  PubMed  Google Scholar 

  26. Roscio F, Bertoglio C, De Luca A, Frattini P, Clerici F, Scandroglio I. Totally laparoscopic resection of the splenic flexure for tumor. Updates Surg. 2012;64(3):185–90.

    Article  PubMed  Google Scholar 

  27. Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A, et al. Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study. Int J Colorectal Dis. 2013.

  28. Kim CW, Shin US, Yu CS, Kim JC. Clinicopathologic characteristics, surgical treatment and outcomes for splenic flexure colon cancer. Cancer Res Treat. 2010;42(2):69–76.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sjo OH, Lunde OC, Nygaard K, Sandvik L, Nesbakken A. Tumour location is a prognostic factor for survival in colonic cancer patients. Colorectal Dis. 2008;10(1):33–40.

    PubMed  CAS  Google Scholar 

  30. Slim K, Panis Y, Alves A, Kwiatkowski F, Mathieu P, Mantion G. Predicting postoperative mortality in patients undergoing colorectal surgery. World J Surg. 2006;30(1):100–6.

    Article  PubMed  Google Scholar 

  31. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis. 2009;11(4):354–64 (discussion 64–5).

    Article  PubMed  CAS  Google Scholar 

  32. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99(6):433–41.

    Article  PubMed  Google Scholar 

  33. Storli K, Sondenaa K, Furnes B, Leh S, Nesvik I, Bru T, et al. Improved lymph node harvest from resected colon cancer specimens did not cause upstaging from TNM stage II to III. World J Surg. 2011;35(12):2796–803.

    Article  PubMed  Google Scholar 

  34. Sjo OH, Merok MA, Svindland A, Nesbakken A. Prognostic impact of lymph node harvest and lymph node ratio in patients with colon cancer. Dis Colon Rectum. 2012;55(3):307–15.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Karen Flashman for data collection. There was no support or funding for this study.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Minimally Invasive Colorectal Unit (MICRU), Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK

    Manfred Odermatt, Najaf Siddiqi, Rose Johns, Danilo Miskovic, Omar Khan, Jim Khan & Amjad Parvaiz

Authors
  1. Manfred Odermatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Najaf Siddiqi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rose Johns
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Danilo Miskovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Omar Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jim Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amjad Parvaiz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manfred Odermatt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Odermatt, M., Siddiqi, N., Johns, R. et al. The short- and long-term outcomes for patients with splenic flexure tumours treated by left versus extended right colectomy are comparable: a retrospective analysis. Surg Today 44, 2045–2051 (2014). https://doi.org/10.1007/s00595-013-0803-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0803-2

Keywords

Search

Navigation