1. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis
- Author
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De'Angelis, N., Martinez-Perez, A., Winter, D. C., Landi, F., Vitali, G. C., Le Roy, B., Coccolini, F., Brunetti, F., Celentano, V., Di Saverio, S., Ris, F., Fuks, D., Espin, E., Bianchi, G., Pham, J., Genova, P., Sobhani, I., Gomez, S. A., Torres, M. T., Paya, C., Gonzalvez, P., Stakelum, A., Zaborowski, A., Sueiras-Gil, A., Hevia, R., Assalino, M., Pezet, D., Abdallah, M., Ansaloni, L., Birindelli, A., Denet, C., Solis, A., Kraft, M., Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Henri Mondor, Addenbrooke's Hospital, Cambridge University NHS Trust, CHU Amiens-Picardie, de'Angelis N., Martinez-Perez A., Winter D.C., Landi F., Vitali G.C., Le Roy B., Coccolini F., Brunetti F., Celentano V., Di Saverio S., Ris F., Fuks D., Espin E., Bianchi G., Pham J., Genova P., Sobhani I., Gomez S.A., Torres M.T., Paya C., Gonzalvez P., Stakelum A., Zaborowski A., Sueiras-Gil A., Hevia R., Assalino M., Pezet D., Abdallah M., Ansaloni L., Birindelli A., Denet C., Solis A., and Kraft M.
- Subjects
Male ,Extended right colectomy ,0302 clinical medicine ,Postoperative Complications ,Colectomy ,ComputingMilieux_MISCELLANEOUS ,Splenic fexure carcinoma ,Aged, 80 and over ,ddc:617 ,Middle Aged ,3. Good health ,Treatment Outcome ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,030211 gastroenterology & hepatology ,Female ,Left colectomy ,Colon, Transverse ,Adult ,medicine.medical_specialty ,Operative Time ,Segmental left colectomy ,Disease-Free Survival ,Resection ,03 medical and health sciences ,Postoperative complications ,Propensity score matching ,Splenic flexure carcinoma ,Internal medicine ,medicine ,Carcinoma ,Humans ,Propensity Score ,Aged ,Retrospective Studies ,Splenic flexure ,business.industry ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,Hepatology ,Length of Stay ,medicine.disease ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,Surgery ,Postoperative complication ,Laparoscopy ,Lymph Nodes ,business ,Abdominal surgery - Abstract
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.
- Published
- 2020
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