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. 2022 Feb;24(2):177-187.
doi: 10.1111/codi.15962. Epub 2021 Nov 9.

Laparoscopic versus open surgery for left flexure colon cancer: A propensity score matched analysis from an international cohort

Corrado Pedrazzani  1 , Giulia Turri  1 , Soo Yeun Park  2 , Koya Hida  3 , Yudai Fukui  3 , Jacopo Crippa  4 , Giovanni Ferrari  5 , Matteo Origi  5 , Gaya Spolverato  6 , Matteo Zuin  6 , Sung Uk Bae  7 , Seong Kyu Baek  7 , Andrea Costanzi  8 , Dario Maggioni  8 , Gyung Mo Son  9 , Andrea Scala  10 , Timothy Rockall  10 , David W Larson  4 , Alfredo Guglielmi  1 , Gyu Seog Choi  2
Affiliations

Laparoscopic versus open surgery for left flexure colon cancer: A propensity score matched analysis from an international cohort

Corrado Pedrazzani et al. Colorectal Dis. 2022 Feb.

Abstract

Aim: Surgical treatment of splenic flexure cancer (SFC) still presents some debated issues, including the role of laparoscopic surgery. The literature is based on small single-centre series, while randomized controlled studies comparing open and laparoscopic treatment for colon cancer exclude SFC. This study aimed to determine the role of laparoscopic surgery in the treatment of SFC, comparing short- and long-term outcomes with open surgery.

Method: This was an international multicentre retrospective cohort study that analysed patients from 10 tertiary referral centres. From a cohort of 641 cases, 484 patients with Stage I-III SFC submitted to elective surgery with curative intent were selected. After 1:1 propensity score matching, 130 patients in the laparoscopic group (LapGroup) were compared with 130 patients in the open surgery group (OpenGroup).

Results: After propensity score matching, the two groups were comparable for demographic and clinical parameters. OpenGroup presented a higher incidence of overall (P = 0.02) and surgery-related complications (P = 0.05) but a similar rate of severe complications (P = 0.75). Length of stay was notably shorter in the LapGroup (P = 0.001). Overall (P = 0.793) as well as cancer-specific survival (P = 0.63) did not differ between the two groups.

Conclusions: Elective laparoscopic surgery for Stage I-III SFC is feasible and associated with improved short-term postoperative outcomes compared to open surgery. Moreover, laparoscopic surgery appears to provide excellent long-term cancer outcomes.

Keywords: colon cancer; laparoscopy; left flexure; prognosis; splenic flexure.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
CONSORT flow diagram with patients' selection process, according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines
FIGURE 2
FIGURE 2
Kaplan–Meier estimates of overall survival probability for patients undergoing laparoscopic and open resection for SFC. (A) OS in the whole population (P = 0.79); (B) Stage I (P = 0.26); (C) Stage II (P = 0.43); (D) Stage III (P = 0.44)
FIGURE 3
FIGURE 3
Kaplan–Meier estimates of cancer‐specific survival probability for patients undergoing laparoscopic and open resection for SFC. (A) CSS in the whole population (P = 0.63); (B) Stage I (P = 0.45); (C) Stage II (P = 0.19); (D) Stage III (P = 0.77)
See this image and copyright information in PMC

References

    1. Pedrazzani C, Turri G, Park SY, Hida K, Fukui Y, Crippa J, et al. Clinical‐pathologic characteristics and long‐term outcomes of left flexure colonic cancer: a retrospective analysis of an international multicenter cohort. Dis Colon Rectum. 2020;63(12):1593–601. - PubMed
    1. Steffen C, Bokey EL, Chapuis PH. Carcinoma of the splenic flexure. Dis Colon Rectum. 1987;30(11):872–4. [cited 2019 Jun 23] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3677963 - PubMed
    1. Aldridge MC, Phillips RKS, Hittinger R, Fry JS, Fielding LP. Influence of tumour site on presentation, management and subsequent outcome in large bowel cancer. Br J Surg. 2005;73(8):663–70. [cited 2019 Jun 23]. 10.1002/bjs.1800730829 - DOI - PubMed
    1. Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H. Comparison of 17,641 patients with right‐ and left‐sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010;53(1):57–64. - PubMed
    1. Kim CW, Shin US, Yu CS, Kim JC. Clinicopathologic characteristics, surgical treatment and outcomes for splenic flexure colon cancer. Cancer Res Treat. 2010;42(2):69–76. - PMC - PubMed