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Laparoscopic segmental left colectomy for splenic flexure carcinoma: a single institution experience

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Abstract

Background

There is ongoing debate regarding surgical treatment of splenic flexure cancer. The main points of controversy include the appropriate extent of colon resection, either to the right or to the left, and the appropriate extent of lymph-node dissection. The aim of this study was to review our experience in laparoscopic treatment of splenic flexure cancer cases and to compare our data to the recent literature.

Methods

Consecutive patients, operated on for splenic flexure colon carcinoma at a single institution between April 2005 and January 2013, were included in the study. Exclusion criteria were a previous history of colorectal cancer, recurrent colonic cancer, emergency cases with an obstructive tumor or a perforated tumor with peritonitis, synchronous cancer, palliative surgery, and a past history of colorectal resection. Patients underwent laparoscopic segmental left colectomy with ligation of the left branch of the middle colic and of the left colic artery. Patient characteristics, operative and postoperative outcomes, and long-term technical, functional, and oncological results from a prospectively maintained database were retrospectively analyzed. After hospital discharge, standardized follow-up was performed at 1 month postoperatively, then every 3 months during the first 2 years, and every 6 months thereafter, for a total of 5 years.

Results

A total of 28 consecutive patients (16 males) with a median age of 71.8 years (range 42.5–88.8 years) were included. Ninety-day mortality was 3.5% and surgical morbidity was 21.5% with anastomotic leak rate of 10.7%. All survivors experienced good or very good functional results. During a median follow-up period of 50.9 months, eight patients (28.5%) presented with a recurrence. The 5-year overall and disease-free survival rates were 46.3% and 39.2%, respectively.

Conclusions

Segmental left colectomy for splenic flexure carcinoma is associated with reasonably low morbidity and very good functional results. However, survival rates are low.

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Acknowledgements

The authors thank Wolters Kluwer and Editage for language, grammar, and terminology checking.

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Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000, Grenoble, France

    Q. Chenevas-Paule, B. Trilling, P. Y. Sage, E. Girard & J. L. Faucheron

  2. University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France

    B. Trilling, E. Girard & J. L. Faucheron

  3. Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France

    J. L. Faucheron

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  1. Q. Chenevas-Paule
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  2. B. Trilling
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  4. E. Girard
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  5. J. L. Faucheron
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Correspondence to J. L. Faucheron.

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Conflict of interest

Jean-Luc Faucheron has a consulting agreement with AMI, Covidien, Medtronic, Ethicon, MSD, Legrand, Janssen-Cilag, and Johnson & Johnson Beauté Santé France. This has had no impact with the results of this study. Quentin Chenevas-Paule, Bertrand Trilling, Pierre-Yves Sage, and Edouard Girard have no conflicts of interest or financial ties to disclose.

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The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Chenevas-Paule, Q., Trilling, B., Sage, P.Y. et al. Laparoscopic segmental left colectomy for splenic flexure carcinoma: a single institution experience. Tech Coloproctol 24, 41–48 (2020). https://doi.org/10.1007/s10151-019-02126-3

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  • DOI: https://doi.org/10.1007/s10151-019-02126-3

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