Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis
Por:
de'Angelis N, Martínez-Pérez A, Winter DC, Landi F, Vitali GC, Le Roy B, Coccolini F, Brunetti F, Celentano V, Di Saverio S, Ris F, Fuks D, Espin E and SFC Study Group
Publicada:
1 feb 2021
Ahead of Print:
1 feb 2020
Categoría:
Surgery
Resumen:
Background The surgical resection of the splenic flexure carcinoma (SFC) is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs. Methods This retrospective multicenter study analyzed the surgical and oncological outcomes of SFC patients undergoing elective curative intent surgery between 2000 and 2018. Descriptive and exploratory analyses were first conducted on the whole sample. Outcomes of the different procedures (ERC vs. LC vs. SLC) were then compared using propensity score matching for multilevel treatment. Overall (OS) and disease-free survival (DFS) were evaluated by Kaplan-Meier method. Results From a total of 399 SFC patients, 143 (35.8%) underwent ERC, 131 (32.8%) underwent LC, and 125 (31.4%) underwent SLC. Overall, 297 (74.4%) were laparoscopic procedures. An increase in operative time, time to flatus, time to regular diet, and hospital stay was observed with the progressive extension of SFC resection. ERC was associated with significantly increased risk of postoperative ileus compared to both LC and SLC. A significantly greater number of lymph nodes were retrieved by ERC, but the objective of at least 12 retrieved lymph nodes was achieved in 85% of patients, without procedure-related differences. No differences were observed in OS or DFS between ERC, LC, and SLC. Conclusion The present study supports the resection of SFCs by colon-sparing surgical techniques, such as SLC.
Filiaciones:
de'Angelis N:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Winter DC:
Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
Landi F:
Department of General Surgery, Viladecans Hospital, Barcelona, Spain
Vitali GC:
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Le Roy B:
Department of Digestive and Hepato-Biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
Coccolini F:
General, Emergency and Trauma Surgery Department, Bufalini Hospital of Cesena, Cesena, Italy
Brunetti F:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Celentano V:
Minimally Invasive Colorectal Unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK
University of Portsmouth, Portsmouth, UK
Di Saverio S:
Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
Ris F:
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Fuks D:
Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
Espin E:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall D'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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