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

Nicola De’angelis, Eloy Espin, Frederic Ris, Filippo Landi, Bertrand Le Roy, Federico Coccolini, Valerio Celentano, Angela Gurrado, Denis Pezet, Giorgio Bianchi, Riccardo Memeo, Giulio C. Vitali, Alejandro Solis, Christine Denet, Salomone Di Saverio, Gian Luigi De’angelis, Miquel Kraft, Paula Gonzálvez-guardiola, Aine Stakelum, Fausto CatenaDavid Fuks, Des C. Winter, Mario Testini, Aleix Martínez-pérez

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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.
Original languageEnglish
Article number20
Number of pages10
JournalWorld Journal of Emergency Surgery
Volume16
Issue number1
DOIs
Publication statusPublished - 29 Apr 2021

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