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Splenic flexure cancer survival: a 25-year experience and implications for complete mesocolic excision (CME) and central vascular ligation (CVL) |
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| Authors: | Krishanth Naidu MS FRACS Pierre H. Chapuis DS (Qld) FRACS Kilian G. M. Brown MBBS MPhil Charles Chan PhD FRCPA Matthew J. F. X. Rickard MMed (Clin Epi) FRACS Kheng-Seong Ng MBiostat PhD FRACS |
| Affiliation: | 1. Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139 Australia;2. Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139 Australia Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139 Australia Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139 Australia Contribution: Data curation, Project administration, Resources, Supervision, Writing - review & editing;3. Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139 Australia Contribution: Data curation, Resources, Writing - review & editing;4. Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139 Australia Department of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, 2139 Australia Contribution: Data curation, Resources, Writing - review & editing;5. Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139 Australia Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139 Australia Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139 Australia Contribution: Resources, Supervision, Writing - review & editing |
| Abstract: | BackgroundThe management of splenic flexure cancers (SFCs) in the era of complete mesocolic excision (CME) and central vascular ligation (CVL) is challenging because of its variable lymphatic drainage. This study aimed to compare survival outcomes for SFCs and non-SFCs, and better understand the clinicopathological characteristics which may define a distinct SFC phenotype.MethodsAn observational cohort study at Concord Hospital, Sydney was conducted with patients who underwent resection for colon adenocarcinoma (1995–2019). Clinicopathological data were extracted from a prospective database. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan–Meier and Cox regression analyses.ResultsOf 2149 patients with colon cancer, 129 (6%) had an SFC. The overall 5-year OS and DFS rates were 63.6% (95% CI 62.5–64.7) and 59.4% (95% CI 58.3–60.5), respectively. SFCs were not associated with OS (P = 0.6) or DFS (P = 0.5). SFCs were more likely to present urgently (P < 0.001) with obstruction (P < 0.001) or perforation (P = 0.03), and more likely to require an open operation (P < 0.001). These characteristics were associated with poorer survival outcomes. No differences were noted between SFCs and non-SFCs with respect to tumour stage (P = 0.3).ConclusionSFCs have a distinct phenotype, the individual characteristics of which are associated with poorer survival. However, the survivals of SFCs and non-SFCs are similar, possibly because the most important determinant of outcome, tumour stage, is no different between the groups. This may have implications for the surgical approach to SFCs with respect to standardization of CME and CVL surgery for these cancers. |
| Keywords: | CME CVL and splenic flexure cancer |