Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Department of Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Tech Coloproctol. 2023 Nov;27(11):1073-1081. doi: 10.1007/s10151-023-02796-0. Epub 2023 Apr 18.
There is an ongoing debate regarding the extent of resection for splenic flexure tumors (SFT). The purpose of this study was to compare segmental and extended resections in terms of overall survival (OS) and pathologic outcomes.
Retrospective analysis of all patients surgically treated for SFT in the National Cancer Database (NCDB) for the period 2010-2019. Outcomes of segmental and extended resections were compared and a 1:1 propensity score matching was used to match for confounders. Primary outcome was OS.
In total 3498/668,852 (0.5%) patients with clinical stage I-III splenic flexure adenocarcinoma in the NCDB were included. Of these, 1533 (43.8%) underwent segmental resection while 1965 (56.1%) underwent extended resection. After matching, mean OS was similar between the groups (92 vs 91 months; p = 0.94). When survival was stratified by clinical N stage, an 8-month survival benefit was shown in the extended resection group for clinical N-positive status (86 vs 78); however, this difference did not achieve statistical significance (p = 0.078). Median number of harvested lymph nodes was significantly lower in the segmental resection group (16 vs 17; p < 0.001) and the percentage of patients with fewer than 12 harvested nodes was significantly higher (18.4% vs 11.6%; p < 0.001). Length of stay was significantly shorter in the segmental resection group (5 vs 6 days; p = 0.027). There were no significant differences between the groups in terms of 30-day readmission or 30- or 90-day mortality.
While segmental and extended resections were associated with similar OS for clinically node-negative SFT, there might be a survival benefit for extended resection in patients with clinical evidence of lymph node involvement.
对于脾曲肿瘤（SFT）的切除范围，目前仍存在争议。本研究旨在比较节段性和广泛性切除术在总生存率（OS）和病理结果方面的差异。
对国家癌症数据库（NCDB）中 2010 年至 2019 年间接受 SFT 手术治疗的所有患者进行回顾性分析。比较节段性和广泛性切除术的结果，并采用 1:1 倾向评分匹配来匹配混杂因素。主要结局为 OS。
在 NCDB 中，共有 668852 例临床分期 I-III 期脾曲腺癌患者纳入本研究，其中 1533 例（43.8%）接受了节段性切除术，1965 例（56.1%）接受了广泛性切除术。匹配后，两组的平均 OS 相似（92 与 91 个月；p=0.94）。当按临床 N 分期对生存情况进行分层时，在临床 N 阳性患者中，广泛性切除术组显示出 8 个月的生存获益（86 与 78 个月；p=0.078），但差异无统计学意义。节段性切除术组的淋巴结采集数量中位数明显较低（16 与 17 个；p<0.001），且淋巴结采集数量少于 12 个的患者比例明显较高（18.4%与 11.6%；p<0.001）。节段性切除术组的住院时间明显较短（5 与 6 天；p=0.027）。两组间 30 天再入院率、30 天或 90 天死亡率无显著差异。
对于临床淋巴结阴性的 SFT，节段性和广泛性切除术的 OS 相似，但对于有临床淋巴结受累证据的患者，广泛性切除术可能有生存获益。
