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.

BACKGROUND Global experience with splenic flexure cancer is limited due to its low incidence. Both limited (segmental) and extended resections are performed, as 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 two arms were well-balanced in regards to sex, BMI, ASA and ECOG 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 min vs. 189 min, 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-y OS 0.84 vs. 0.83, 5-y PFS 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 mostly based 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.