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Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes.
Kohn, Julia F; Boatman, Sonja; Wang, Qi; Marmor, Schelomo; Hassan, Imran; Madoff, Robert D; Gaertner, Wolfgang B; Goffredo, Paolo.
Afiliación
  • Kohn JF; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
  • Boatman S; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
  • Wang Q; Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA.
  • Marmor S; Center for Clinical Quality and Outcomes Discovery and Evaluation (C-QODE), University of Minnesota, Minneapolis, Minnesota, USA.
  • Hassan I; Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Madoff RD; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
  • Gaertner WB; Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
  • Goffredo P; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Colorectal Dis ; 2024 Sep 18.
Article en En | MEDLINE | ID: mdl-39295157
ABSTRACT

AIM:

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.

METHOD:

The Surveillance, Epidemiology and End Results database was searched for adults with Stage I-III splenic flexure adenocarcinoma, 2004-2019.

RESULTS:

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.

CONCLUSIONS:

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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Colorectal Dis Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Colorectal Dis Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido