Indeed, no prior study has considered emergency SFC resections exclusively. Although SFCs have been associated with a poorer prognosis than cancers from other colonic subsites due to the high risk of bowel obstruction, the number of emergency cases reported in the literature is limited. In contrast, the outcomes of these different resections when performed in acute clinical situations remain substantially unexplored. Consequently, a more conservative SLC, for a long time considered oncologically inadequate, is considered a safe and effective option for the treatment of SFCs. Indeed, two recent meta-analyses concluded that no procedure-related difference exists in terms of postoperative morbidity, mortality, lymph node yield, and patient survival. All these procedures are considered alternatives for curative resections of these tumors, which are located on the border between the right and left colon and have dual lymphatic drainage toward the superior and inferior mesenteric vessels. Despite a substantial lack of standardization regarding the nomenclature of the different surgical alternatives to resect SFCs, three main surgical procedures are performed, namely, extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC). In recent years, however, several studies have questioned which type of resection would provide the best surgical and oncological outcomes in patients with SFCs. The surgical treatment of splenic flexure carcinoma (SFC) has been traditionally neglected in the literature, mainly because of its relatively low incidence, as it represents only 3 to 5% of all colonic cancers. Nonetheless, all the alternatives seem to provide similar pathologic and long-term outcomes, supporting the oncological safety of more conservative resections for emergency SFCs. ERC is associated with increased odds of severe postoperative complications when compared to more conservative SFC resections. In the emergency setting, ERC and open surgery are the most frequently performed procedures. 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. R0 resection was achieved in 98.9% of the procedures, and ≥ 12 lymph nodes were retrieved in 92.2% of patients. Anastomotic leakage occurred in 8 (11.2%) patients, with no differences between the groups ( p = 0.902). 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. 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. 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%). Extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC) were evaluated and compared. For the present analysis, SFC patients were selected if they had received emergency surgical resection with curative intent between 20. This multicenter retrospective study was based on the SFC Study Group database. This study aims to compare the perioperative and long-term outcomes of different alternatives for emergency SFC resection. The effectiveness of surgical treatment for splenic flexure carcinomas (SFCs) in emergency settings remains unexplored.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |