Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA.
Colorectal Dis. 2024 Nov;26(11):1883-1891. doi: 10.1111/codi.17172. Epub 2024 Sep 18.
The optimal extent of resection for splenic flexure adenocarcinoma remains debated. These tumours straddle the left- and right-sided vasculature with lymphatic drainage in a watershed area; current guidelines recommend either segmental or extended colectomy. We analysed surgical management of splenic flexure tumours and compared outcomes between approaches.
The Surveillance, Epidemiology and End Results database was searched for adults with Stage I-III splenic flexure adenocarcinoma, 2004-2019.
Of 5238 patients, 55% underwent extended colectomy. Compared to segmental colectomy, these patients were more likely to have advanced stage. On multivariable analysis, age ≤ 65 years remained independently associated with extended colectomy. Although fewer nodes were examined in segmental colectomy (median 14 vs. 16, p < 0.001), the number of positive nodes (both, median 0 [interquartile ratio 0-2], p = 0.20) and the lymph node ratio were similar between cohorts. Surgical approach was not significantly associated with increased positive nodal yield in adjusted analyses. Five-year overall and disease-specific survival were 73% and 84% for segmental and 72% and 83% for extended colectomy (p > 0.4); these remained comparable after adjustment.
Nationally, we observed similar rates of segmental and extended colectomy for splenic flexure adenocarcinoma. Extended colectomy was not more common in Stage III disease, indicating lack of stage migration, and was not associated with better oncological outcomes. These observations support current practice involving either approach, which should be tailored to patient-related factors and preferences, while considering technical aspects and quality of life.
对于脾曲结肠癌的最佳切除范围仍存在争议。这些肿瘤横跨左侧和右侧血管，淋巴引流位于分水岭区域；目前的指南建议行节段或扩大结肠切除术。我们分析了脾曲肿瘤的手术治疗方法，并比较了两种方法的结果。
在 2004 年至 2019 年期间，我们检索了 Surveillance, Epidemiology and End Results 数据库中 I-III 期脾曲腺癌患者的资料。
在 5238 名患者中，55%接受了扩大结肠切除术。与节段性结肠切除术相比，这些患者更有可能处于晚期。多变量分析显示，年龄≤65 岁与扩大结肠切除术独立相关。尽管节段性结肠切除术检查的淋巴结数量较少（中位数 14 比 16，p<0.001），但阳性淋巴结的数量（中位数均为 0 [四分位距 0-2]，p=0.20）和淋巴结比率在两组间相似。调整后的分析表明，手术方式与阳性淋巴结检出率的增加无关。在调整后，节段性和扩大结肠切除术的 5 年总生存率和疾病特异性生存率分别为 73%和 84%、72%和 83%（p>0.4），这些结果仍然相似。
在全国范围内，我们观察到脾曲结肠癌行节段性和扩大结肠切除术的比例相似。III 期疾病中扩大结肠切除术并不更常见，这表明没有分期迁移，并且与更好的肿瘤学结果无关。这些观察结果支持目前涉及两种方法的实践，应根据患者相关因素和偏好进行个体化选择，同时考虑技术方面和生活质量。
