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Multicenter Study
. 2021 Apr 29;16(1):20.
doi: 10.1186/s13017-021-00365-0.

Emergency surgery for splenic flexure cancer: results of the SFC Study Group database

Nicola de'Angelis  1   2 , Eloy Espin  3 , Frederic Ris  4 , Filippo Landi  5 , Bertrand Le Roy  6 , Federico Coccolini  7 , Valerio Celentano  8   9 , Angela Gurrado  10 , Denis Pezet  6 , Giorgio Bianchi  1 , Riccardo Memeo  11 , Giulio C Vitali  4 , Alejandro Solis  3 , Christine Denet  12 , Salomone Di Saverio  13 , Gian Luigi de'Angelis  14 , Miquel Kraft  3 , Paula Gonzálvez-Guardiola  15 , Aine Stakelum  16 , Fausto Catena  17 , David Fuks  12 , Des C Winter  16 , Mario Testini  10 , Aleix Martínez-Pérez  1 ; SFC Study Group
Affiliations
Multicenter Study

Emergency surgery for splenic flexure cancer: results of the SFC Study Group database

Nicola de'Angelis et al. World J Emerg Surg. .

Abstract

Background: The effectiveness of surgical treatment for splenic flexure carcinomas (SFCs) in emergency settings remains unexplored. This study aims to compare the perioperative and long-term outcomes of different alternatives for emergency SFC resection.

Method: This multicenter retrospective study was based on the SFC Study Group database. For the present analysis, SFC patients were selected if they had received emergency surgical resection with curative intent between 2000 and 2018. Extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC) were evaluated and compared.

Results: The study sample was composed of 90 SFC patients who underwent emergency ERC (n = 55, 61.1%), LC (n = 18, 20%), or SLC (n = 17, 18.9%). Bowel obstruction was the most frequent indication for surgery (n = 75, 83.3%), and an open approach was chosen in 81.1% of the patients. A higher incidence of postoperative complications was observed in the ERC group (70.9%) than in the LC (44.4%) and SLC groups (47.1%), with a significant procedure-related difference for severe postoperative complications (Dindo-Clavien ≥ III; adjusted odds ratio for ERC vs. LC:7.23; 95% CI 1.51-34.66; p = 0.013). Anastomotic leakage occurred in 8 (11.2%) patients, with no differences between the groups (p = 0.902). R0 resection was achieved in 98.9% of the procedures, and ≥ 12 lymph nodes were retrieved in 92.2% of patients. Overall and disease-free survival rates at 5 years were similar between the groups and were significantly associated with stage pT4 and the presence of synchronous metastases.

Conclusion: In the emergency setting, ERC and open surgery are the most frequently performed procedures. ERC is associated with increased odds of severe postoperative complications when compared to more conservative SFC resections. Nonetheless, all the alternatives seem to provide similar pathologic and long-term outcomes, supporting the oncological safety of more conservative resections for emergency SFCs.

Keywords: Cancer; Colectomy; Emergency surgery; Mortality; Splenic flexure carcinoma; Survival.

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Conflict of interest statement

All authors declare that they have no competing interests in relation to the matter of this publication.

Figures

Fig. 1
Fig. 1
Study sample selection flowchart from the SFC Study Group database. ERC, extended right colectomy; LC, left colectomy; SLC, segmental left colectomy for splenic flexure carcinomas (SFCs)
Fig. 2
Fig. 2
Survival analyses (Kaplan-Meier method) for overall survival for SFC patients operated on by ERC (extended right colectomy), LC (left colectomy), and SLC (segmental left colectomy)
Fig. 3
Fig. 3
Survival analyses (Kaplan-Meier method) for disease-free survival for SFC patients operated on by ERC (extended right colectomy), LC (left colectomy), and SLC (segmental left colectomy)
See this image and copyright information in PMC

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