TY - JOUR
T1 - Segmental Colonic Resection Is a Safe and Effective Treatment Option for Colon Cancer of the Splenic Flexure: A Nationwide Retrospective Study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group
AU - Degiuli, Maurizio
AU - Reddavid, Rossella
AU - Ricceri, Fulvio
AU - Di Candido, Francesca
AU - Ortenzi, Monica
AU - Elmore, Ugo
AU - Belluco, Claudio
AU - Rosati, Riccardo
AU - Guerrieri, Marco
AU - Spinelli, Antonino
AU - De Nardi, Paola
AU - Cianflocca, Desiree
AU - Borghi, Felice
AU - Rega, Daniela
AU - Delrio, Paolo
AU - Milone, Marco
AU - Milone, Maria
AU - Domenico De Palma, Giovanni
AU - Restivo, Angelo
AU - Restivo, Attilio
AU - Deidda, Simona
AU - Deidda, Silvia
AU - Testa, Silvio
AU - Scansetti, Mario
AU - Baldazzi, Gianandrea
AU - Cassini, Diletta
AU - Scabini, Stefano
AU - Sparavigna, Marco
AU - Gentilli, Sergio
AU - Monni, Manuela
AU - Monni, Denise Michela
AU - Marchegiani, Francesco
AU - Zuin, Matteo
AU - Sorisio, Vincenzo
AU - Castelano, Edoardo
AU - Polastri, Roberto
AU - Maiello, Fabio
AU - Piccoli, Micaela
AU - Pecchini, Francesca
AU - Ferrero, Alessandro
AU - Mineccia, Michela
AU - Parini, Dario
AU - D'Ugo, Domenico
AU - Biondi, Alberto
AU - Cavaliere, Davide
AU - Solaini, Leonardo
AU - Carlini, Massimo
AU - Spoletini, Domenico
AU - Olivieri, Matteo
AU - Anania, Gabriele
AU - Bombardini, Cristina
AU - Coco, Claudio
AU - Rizzo, Gianluca
AU - Rigamonti, Marco
AU - Zuolo, Michele
AU - Belli, Andrea
AU - Bianco, Francesco
AU - Bianco, Flaviana
AU - Roviello, Franco
AU - Pollesel, Sara
AU - Di Leo, Alberto
AU - Carafa, Francesco
AU - Paolo Bianchi, Pietro
AU - Giuliani, Giuseppe
AU - Muratore, Andrea
AU - Marsanic, Patrizia
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Global experience with splenic flexure cancer is limited because of its low incidence. Both limited (segmental) and extended resections are performed, because agreement on which is the adequate procedure has not been reached. OBJECTIVE: The purpose of this study was to investigate whether segmental resection is as safe and effective as extended resection. DESIGN: This nationwide retrospective cohort study included all consecutive resections of splenic flecure cancer between January 2006 and December 2016 using data from the National Colorectal Cancer Network of the Italian Society of Surgical Oncology following the guidelines set out in the STROBE statement. SETTING: Data were obtained for 31 Italian Referral Centers for Colorectal Surgery. PATIENTS: A total of 1304 patients were submitted to resection of the splenic flexure (n = 791, 60.7%) or extended procedures (extended right and left colectomies; n = 513, 39.3%). MAIN OUTCOME MEASURES: We evaluated Clavien-Dindo ≥3 postoperative complications and oncological (number of lymph nodes removed, length of free proximal and distal margins, rate of R0 resections) and survival outcomes. RESULTS: The 2 arms were well balanced in regard to sex, BMI, ASA and Eastern Cooperative Oncology Group scores, and disease stage. Limited resection was performed more frequently using a minimally invasive approach (62.1% vs 50.9%, p < 0.001) and with shorter operation times than extended procedures (165 vs 189 minutes, p < 0.001), but the same Clavien-Dindo ≥3 postoperative complications (6.44% vs 6.43%, p = 0.99), 30-day mortality (0.63% vs 0.38%), oncological outcomes, and survival rates (5-year overall survival 0.84 vs 0.83, 5-year progression-free survival 0.85 vs 0.84). LIMITATIONS: There are limitations inherent to the retrospective nature of the study and a potential lack of consistency in treatment across centers over time. Indications as to why a specific operation was chosen were based mostly on surgeons' beliefs. CONCLUSIONS: Segmental resection is a safe and effective treatment option for cancer of the splenic flexure. See Video Abstract at http://links.lww.com/DCR/B307.
AB - BACKGROUND: Global experience with splenic flexure cancer is limited because of its low incidence. Both limited (segmental) and extended resections are performed, because agreement on which is the adequate procedure has not been reached. OBJECTIVE: The purpose of this study was to investigate whether segmental resection is as safe and effective as extended resection. DESIGN: This nationwide retrospective cohort study included all consecutive resections of splenic flecure cancer between January 2006 and December 2016 using data from the National Colorectal Cancer Network of the Italian Society of Surgical Oncology following the guidelines set out in the STROBE statement. SETTING: Data were obtained for 31 Italian Referral Centers for Colorectal Surgery. PATIENTS: A total of 1304 patients were submitted to resection of the splenic flexure (n = 791, 60.7%) or extended procedures (extended right and left colectomies; n = 513, 39.3%). MAIN OUTCOME MEASURES: We evaluated Clavien-Dindo ≥3 postoperative complications and oncological (number of lymph nodes removed, length of free proximal and distal margins, rate of R0 resections) and survival outcomes. RESULTS: The 2 arms were well balanced in regard to sex, BMI, ASA and Eastern Cooperative Oncology Group scores, and disease stage. Limited resection was performed more frequently using a minimally invasive approach (62.1% vs 50.9%, p < 0.001) and with shorter operation times than extended procedures (165 vs 189 minutes, p < 0.001), but the same Clavien-Dindo ≥3 postoperative complications (6.44% vs 6.43%, p = 0.99), 30-day mortality (0.63% vs 0.38%), oncological outcomes, and survival rates (5-year overall survival 0.84 vs 0.83, 5-year progression-free survival 0.85 vs 0.84). LIMITATIONS: There are limitations inherent to the retrospective nature of the study and a potential lack of consistency in treatment across centers over time. Indications as to why a specific operation was chosen were based mostly on surgeons' beliefs. CONCLUSIONS: Segmental resection is a safe and effective treatment option for cancer of the splenic flexure. See Video Abstract at http://links.lww.com/DCR/B307.
KW - Cancer of the splenic flexure
KW - Extended left colectomy
KW - Segmental colonic resection
KW - Limited resection
KW - Resection of the splenic flexure
KW - Extended right colectomy
KW - Cancer of the splenic flexure
KW - Extended left colectomy
KW - Segmental colonic resection
KW - Limited resection
KW - Resection of the splenic flexure
KW - Extended right colectomy
UR - http://hdl.handle.net/10807/303532
U2 - 10.1097/DCR.0000000000001743
DO - 10.1097/DCR.0000000000001743
M3 - Article
SN - 0012-3706
VL - 63
SP - 1372
EP - 1382
JO - DISEASES OF THE COLON & RECTUM
JF - DISEASES OF THE COLON & RECTUM
ER -