Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, 80131, Italy.
Medical Statistics Unit, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy.
Sci Rep. 2019 Jul 29;9(1):10953. doi: 10.1038/s41598-019-47548-z.
Extended right or left hemicolectomy are the most common surgical treatments for splenic flexure colon cancer. 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. Between January 2006 and May 2016, 103 patients with splenic flexure colon cancer were enrolled in the study. We evaluated the clinicopathological findings and outcomes of all patients and associated them to the different surgical treatment. 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. The tumor infiltrated near organs (T4) in 5 patients. No significant differences in complications were found among the three groups. In all groups no differences were found in the total number of harvested lymphnodes. After a median follow-up of 42 months, 30 recurrences and 19 deaths occurred (12 for tumor progression). There was no difference in overall and progression free survival among the three different surgical treatments. 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. It is our opinion that the extended surgery is seldomly indicated to cure splenic flexure cancer.
扩大右半结肠切除术或扩大左半结肠切除术是治疗脾曲结肠癌最常见的手术方法。由于脾曲部位的淋巴引流定义不明确，被认为是异质性的，因此常需要进行扩大切除术（包括远端胰腺切除术和/或脾切除术）。2006 年 1 月至 2016 年 5 月，我们共纳入了 103 例脾曲结肠癌患者。我们评估了所有患者的临床病理发现和结果，并将其与不同的手术治疗相关联。在 103 例选定病例中，22 例（21.4%）患者行扩大右半结肠切除术，24 例（23.3%）患者行扩大左半结肠切除术，57 例（55.3%）患者行脾曲节段切除术；11 例（10.7%）患者联合切除了有肿瘤粘连的邻近器官。5 例患者肿瘤侵犯临近器官（T4）。三组患者之间的并发症发生率无显著差异。在所有组中，总淋巴结采集数无差异。中位随访 42 个月后，30 例患者复发，19 例患者死亡（12 例死于肿瘤进展）。三种不同手术治疗方法在总生存率和无进展生存率方面无差异。根据我们的结果，脾曲节段切除术与预后不良无关，且可获得满意的肿瘤学结果。我们认为，扩大手术很少能治愈脾曲结肠癌。
