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Laparoscopic resection with complete mesocolic excision for splenic flexure cancer: long-term follow-up data from a multicenter retrospective study

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Abstract

Background

Splenic flexure cancer (SFC), identified as tumors raised in the distal transverse colon and proximal descending colon, accounts for 2 to 5% of all surgically treated colorectal cancers. Despite the fact that the laparoscopic approach has become the gold standard for many colorectal procedures, it has never been extensively investigated in SFC due to lack of an agreed consensus on the appropriate operative procedure. The aim of this multicenter retrospective study is to evaluate the oncologic value of laparoscopic segmental resection with complete mesocolic excision (CME) for cancer located in the splenic flexure.

Methods

All data of consecutive patients who had undergone laparoscopic resection with CME for SFC from January 2005 to December 2017 at five different tertiary centers were retrospectively analyzed. The Kaplan–Meier (KM) test was used to assess the overall survival (OS) and the disease-free survival (DFS) rates after surgery. Univariate Cox regression was used to explore the association between OS and other independent factors.

Results

Recurrence was observed in 13 (11.6%) patients and a significant association between disease stage and recurrence (P < 0.001) was found with a higher proportion of stage IV patients in the recurrence group (46.1% vs. 7.1%). During a median follow-up of 43 months (range 12–149), 13 deaths occurred, all of them due to disease progression. KM curves for all stages showed an estimated survival rate of 51% at 148 months.

Conclusion

Laparoscopic segmental resection with CME appears to be an oncologically safe and effective procedure for treatment of SFC and may be considered as a standard surgical method for elective management of the disease. In the future, routine lymph node mapping could be used to confirm this hypothesis.

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Acknowledgements

We thank Juliet Ippolito, B.A. Vassar College, MPhil University of Dundee for English language editing.

Funding

No funding has been received for this work.

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Authors and Affiliations

  1. Department Gastroenterology, Endocrinology and Surgical Endoscopy, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy

    Umberto Bracale, Giovanni Merola, Francesco Corcione & Giovanni Domenico De Palma

  2. Department of General Surgery II, Spedali Civili, Brescia, Italy

    Giusto Pignata

  3. Department of General and Mininvasive Surgery, San Camillo Hospital, Trento, Italy

    Giusto Pignata

  4. Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy

    Francesco Corcione & Diego Cuccurullo

  5. Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy

    Felice Pirozzi & Antonio Sciuto

  6. Department of General Surgery, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Elisa Cassinotti & Luigi Boni

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  1. Umberto Bracale
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  2. Giovanni Merola
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Correspondence to Umberto Bracale.

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Umberto Bracale, Giovanni Merola, Antonio Sciuto, Giusto Pignata, Francesco Corcione, Luigi Boni, Elisa Cassinotti, Felice Pirozzi, Diego Cuccurullo, and Giovanni Domenico De Palma have no conflicts of interest or financial ties to disclose.

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Bracale, U., Merola, G., Pignata, G. et al. Laparoscopic resection with complete mesocolic excision for splenic flexure cancer: long-term follow-up data from a multicenter retrospective study. Surg Endosc 34, 2954–2962 (2020). https://doi.org/10.1007/s00464-019-07078-1

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