Naidu Krishanth, Chapuis Pierre H, Brown Kilian G M, Chan Charles, Rickard Matthew J F X, Ng Kheng-Seong
Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia.
Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia.
ANZ J Surg. 2023 Jul-Aug;93(7-8):1861-1869. doi: 10.1111/ans.18434. Epub 2023 Mar 28.
The management of splenic flexure cancers (SFCs) in the era of complete mesocolic excision (CME) and central vascular ligation (CVL) is challenging because of its variable lymphatic drainage. This study aimed to compare survival outcomes for SFCs and non-SFCs, and better understand the clinicopathological characteristics which may define a distinct SFC phenotype.
An observational cohort study at Concord Hospital, Sydney was conducted with patients who underwent resection for colon adenocarcinoma (1995-2019). Clinicopathological data were extracted from a prospective database. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan-Meier and Cox regression analyses.
Of 2149 patients with colon cancer, 129 (6%) had an SFC. The overall 5-year OS and DFS rates were 63.6% (95% CI 62.5-64.7) and 59.4% (95% CI 58.3-60.5), respectively. SFCs were not associated with OS (P = 0.6) or DFS (P = 0.5). SFCs were more likely to present urgently (P < 0.001) with obstruction (P < 0.001) or perforation (P = 0.03), and more likely to require an open operation (P < 0.001). These characteristics were associated with poorer survival outcomes. No differences were noted between SFCs and non-SFCs with respect to tumour stage (P = 0.3).
SFCs have a distinct phenotype, the individual characteristics of which are associated with poorer survival. However, the survivals of SFCs and non-SFCs are similar, possibly because the most important determinant of outcome, tumour stage, is no different between the groups. This may have implications for the surgical approach to SFCs with respect to standardization of CME and CVL surgery for these cancers.
在完整结肠系膜切除术（CME）和中央血管结扎术（CVL）时代，脾曲癌（SFC）的治疗具有挑战性，因为其淋巴引流多变。本研究旨在比较SFC与非SFC的生存结局，并更好地了解可能定义独特SFC表型的临床病理特征。
在悉尼康科德医院进行了一项观察性队列研究，研究对象为接受结肠腺癌切除术的患者（1995 - 2019年）。临床病理数据从一个前瞻性数据库中提取。采用Kaplan-Meier法和Cox回归分析研究总生存（OS）和无病生存（DFS）估计值及其与临床病理变量的关联。
在2149例结肠癌患者中，129例（6%）患有SFC。总体5年OS率和DFS率分别为63.6%（95%CI 62.5 - 64.7）和59.4%（95%CI 58.3 - 60.5）。SFC与OS（P = 0.6）或DFS（P = 0.5）无关。SFC更有可能因梗阻（P < 0.001）或穿孔（P = 0.03）而急诊就诊（P < 0.001），并且更有可能需要进行开放手术（P < 0.001）。这些特征与较差的生存结局相关。SFC与非SFC在肿瘤分期方面无差异（P = 0.3）。
SFC具有独特的表型，其个体特征与较差的生存相关。然而，SFC和非SFC的生存率相似，可能是因为结局的最重要决定因素，即肿瘤分期，在两组之间并无差异。这可能对SFC的手术方式在这些癌症的CME和CVL手术标准化方面具有启示意义。
