Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes
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Wiley
2024
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| _version_ | 1867021922853715968 |
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| author | Julia F. Kohn Sonja Boatman Qi Wang Schelomo Marmor Imran Hassan Robert D. Madoff Wolfgang B. Gaertner Paolo Goffredo |
| author_facet | Julia F. Kohn Sonja Boatman Qi Wang Schelomo Marmor Imran Hassan Robert D. Madoff Wolfgang B. Gaertner Paolo Goffredo Julia F. Kohn Sonja Boatman Qi Wang Schelomo Marmor Imran Hassan Robert D. Madoff Wolfgang B. Gaertner Paolo Goffredo |
| collection | Wiley Open Access |
| contents | Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes Julia F. Kohn Sonja Boatman Qi Wang Schelomo Marmor Imran Hassan Robert D. Madoff Wolfgang B. Gaertner Paolo Goffredo Colorectal Disease AbstractAimThe optimal extent of resection for splenic flexure adenocarcinoma remains debated. These tumours straddle the left‐ and right‐sided vasculature with lymphatic drainage in a watershed area; current guidelines recommend either segmental or extended colectomy. We analysed surgical management of splenic flexure tumours and compared outcomes between approaches.MethodThe Surveillance, Epidemiology and End Results database was searched for adults with Stage I–III splenic flexure adenocarcinoma, 2004–2019.ResultsOf 5238 patients, 55% underwent extended colectomy. Compared to segmental colectomy, these patients were more likely to have advanced stage. On multivariable analysis, age ≤ 65 years remained independently associated with extended colectomy. Although fewer nodes were examined in segmental colectomy (median 14 vs. 16, p < 0.001), the number of positive nodes (both, median 0 [interquartile ratio 0–2], p = 0.20) and the lymph node ratio were similar between cohorts. Surgical approach was not significantly associated with increased positive nodal yield in adjusted analyses. Five‐year overall and disease‐specific survival were 73% and 84% for segmental and 72% and 83% for extended colectomy (p > 0.4); these remained comparable after adjustment.ConclusionsNationally, we observed similar rates of segmental and extended colectomy for splenic flexure adenocarcinoma. Extended colectomy was not more common in Stage III disease, indicating lack of stage migration, and was not associated with better oncological outcomes. These observations support current practice involving either approach, which should be tailored to patient‐related factors and preferences, while considering technical aspects and quality of life. 10.1111/codi.17172 http://creativecommons.org/licenses/by-nc/4.0/ |
| doi_str_mv | 10.1111/codi.17172 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_codi_17172 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc/4.0/ |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes Julia F. Kohn Sonja Boatman Qi Wang Schelomo Marmor Imran Hassan Robert D. Madoff Wolfgang B. Gaertner Paolo Goffredo Colorectal Disease Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes Julia F. Kohn Sonja Boatman Qi Wang Schelomo Marmor Imran Hassan Robert D. Madoff Wolfgang B. Gaertner Paolo Goffredo Colorectal Disease AbstractAimThe optimal extent of resection for splenic flexure adenocarcinoma remains debated. These tumours straddle the left‐ and right‐sided vasculature with lymphatic drainage in a watershed area; current guidelines recommend either segmental or extended colectomy. We analysed surgical management of splenic flexure tumours and compared outcomes between approaches.MethodThe Surveillance, Epidemiology and End Results database was searched for adults with Stage I–III splenic flexure adenocarcinoma, 2004–2019.ResultsOf 5238 patients, 55% underwent extended colectomy. Compared to segmental colectomy, these patients were more likely to have advanced stage. On multivariable analysis, age ≤ 65 years remained independently associated with extended colectomy. Although fewer nodes were examined in segmental colectomy (median 14 vs. 16, p < 0.001), the number of positive nodes (both, median 0 [interquartile ratio 0–2], p = 0.20) and the lymph node ratio were similar between cohorts. Surgical approach was not significantly associated with increased positive nodal yield in adjusted analyses. Five‐year overall and disease‐specific survival were 73% and 84% for segmental and 72% and 83% for extended colectomy (p > 0.4); these remained comparable after adjustment.ConclusionsNationally, we observed similar rates of segmental and extended colectomy for splenic flexure adenocarcinoma. Extended colectomy was not more common in Stage III disease, indicating lack of stage migration, and was not associated with better oncological outcomes. These observations support current practice involving either approach, which should be tailored to patient‐related factors and preferences, while considering technical aspects and quality of life. 10.1111/codi.17172 http://creativecommons.org/licenses/by-nc/4.0/ |
| title | Splenic flexure adenocarcinoma: A national cohort analysis of extent of surgical resection and outcomes |
| topic | Colorectal Disease |
| url | https://onlinelibrary.wiley.com/doi/10.1111/codi.17172 |