Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
Colorectal Dis. 2023 Mar;25(3):431-442. doi: 10.1111/codi.16387. Epub 2022 Nov 13.
The applicability of laparoscopic D3 oncological resection for splenic flexure cancer (SFC) surgery has not been fully explored due to technical difficulties and variations in surgical procedure. The aim of this work is to describe the feasibility of performing laparoscopic D3 resection in SFC and its impact on long-term survival.
A retrospective study on 47 out of 52 consecutive patients who underwent elective laparoscopic colectomy for SFC from December 2006 until December 2019 at Korea University Anam Hospital was performed. Data on patients' demographic and clinical features, surgical procedures, intraoperative and postoperative complications, pathological features and follow-up were collected. Categorical data are expressed as frequencies (n) and percentages (%). Continuous data are expressed as mean ± standard deviation and median (range). The Kaplan-Meier test was used to determine the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS).
The median age of patients was 67.0 years (range 27-87 years) and 72.3% were men. Ten (21.3%) patients presented with an obstructing tumour and underwent an elective laparoscopic colectomy, while 68.1% of patients presented with Stage II and III disease. The conversion rate was 4.3% and the morbidity rate was 31.9%. There was one postoperative death secondary to splenic infarction and anastomotic leak leading to multi-organ failure. Four deaths occurred due to disease progression during a median follow-up of 63.8 months. The rate of recurrence was 20%, the 5-year OS was 89.6% and the 5-year PFS was 72.9%. After R0 resection, the 5-year OS was 91.5% and the 5-year DFS was 74.5%.
Laparoscopic D3 colectomy for SFC is feasible, with an acceptable morbidity and long-term oncological outcome when performed by highly skilled laparoscopic colorectal surgeons with knowledge of the complex anatomy around the splenic flexure. Further randomized trials should be performed to determine the advantage of laparoscopic D3 colectomy over conventional colectomy for SFC.
由于技术难度和手术程序的差异，腹腔镜 D3 肿瘤切除术在脾曲结肠癌（SFC）手术中的适用性尚未得到充分探索。本研究旨在描述在 SFC 中进行腹腔镜 D3 切除的可行性及其对长期生存的影响。
回顾性分析 2006 年 12 月至 2019 年 12 月期间，韩国大学安岩医院连续 52 例 SFC 患者接受择期腹腔镜结肠切除术的资料。收集患者的人口统计学和临床特征、手术过程、术中及术后并发症、病理特征和随访等数据。分类数据用频率（n）和百分比（%）表示。连续数据用均数±标准差和中位数（范围）表示。采用 Kaplan-Meier 检验评估总生存（OS）、无进展生存（PFS）和无病生存（DFS）。
患者的中位年龄为 67.0 岁（范围 27-87 岁），72.3%为男性。10 例（21.3%）患者因肿瘤阻塞而接受择期腹腔镜结肠切除术，68.1%的患者为 II 期和 III 期疾病。转换率为 4.3%，发病率为 31.9%。有 1 例术后死亡，继发于脾梗死和吻合口漏导致多器官功能衰竭。中位随访 63.8 个月期间，因疾病进展死亡 4 例。复发率为 20%，5 年 OS 为 89.6%，5 年 PFS 为 72.9%。RO 切除后，5 年 OS 为 91.5%，5 年 DFS 为 74.5%。
当由熟练的腹腔镜结直肠外科医生进行手术，并且对脾曲周围复杂解剖结构有充分了解时，腹腔镜 D3 结肠切除术治疗 SFC 是可行的，其发病率和长期肿瘤学结果可接受。应进行进一步的随机试验以确定腹腔镜 D3 结肠切除术相对于传统结肠切除术治疗 SFC 的优势。
