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Emergency surgery for splenic flexure cancer: results of the SFC Study Group database

Authors
  • de’Angelis, Nicola1, 2
  • Espin, Eloy3
  • Ris, Frederic4
  • Landi, Filippo5
  • Le Roy, Bertrand6
  • Coccolini, Federico7
  • Celentano, Valerio8, 9
  • Gurrado, Angela10
  • Pezet, Denis6
  • Bianchi, Giorgio1
  • Memeo, Riccardo1
  • Vitali, Giulio C.4
  • Solis, Alejandro3
  • Denet, Christine11
  • Di Saverio, Salomone12
  • de’Angelis, Gian Luigi13
  • Kraft, Miquel3
  • Gonzálvez-Guardiola, Paula14
  • Stakelum, Aine15
  • Catena, Fausto16
  • And 4 more
  • 1 General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy , Bari (Italy)
  • 2 UPEC, Créteil, France , Créteil (France)
  • 3 University Hospital Vall d’Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain , Barcelona (Spain)
  • 4 Geneva University Hospitals and Medical School, Geneva, Switzerland , Geneva (Switzerland)
  • 5 Viladecans Hospital, Barcelona, Spain , Barcelona (Spain)
  • 6 CHU Clermont-Ferrand, Clermont-Ferrand, France , Clermont-Ferrand (France)
  • 7 Bufalini Hospital, Cesena, Italy , Cesena (Italy)
  • 8 Portsmouth Hospitals NHS Trust, Portsmouth, UK , Portsmouth (United Kingdom)
  • 9 University of Portsmouth, Portsmouth, UK , Portsmouth (United Kingdom)
  • 10 University of Bari “Aldo Moro” Medical School, Bari, Italy , Bari (Italy)
  • 11 Paris Descartes University, Paris, France , Paris (France)
  • 12 Cambridge Biomedical Campus, Cambridge, UK , Cambridge (United Kingdom)
  • 13 University of Parma, Parma, Italy , Parma (Italy)
  • 14 Hospital Universitario Doctor Peset, Valencia, Spain , Valencia (Spain)
  • 15 St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland , Dublin 4 (Ireland)
  • 16 Parma University Hospital, Parma, Italy , Parma (Italy)
Type
Published Article
Journal
World Journal of Emergency Surgery
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Apr 29, 2021
Volume
16
Issue
1
Identifiers
DOI: 10.1186/s13017-021-00365-0
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe effectiveness of surgical treatment for splenic flexure carcinomas (SFCs) in emergency settings remains unexplored. This study aims to compare the perioperative and long-term outcomes of different alternatives for emergency SFC resection.MethodThis multicenter retrospective study was based on the SFC Study Group database. For the present analysis, SFC patients were selected if they had received emergency surgical resection with curative intent between 2000 and 2018. Extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC) were evaluated and compared.ResultsThe 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%). 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. 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. LC:7.23; 95% CI 1.51-34.66; p = 0.013). Anastomotic leakage occurred in 8 (11.2%) patients, with no differences between the groups (p = 0.902). R0 resection was achieved in 98.9% of the procedures, and ≥ 12 lymph nodes were retrieved in 92.2% of patients. 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.ConclusionIn the emergency setting, ERC and open surgery are the most frequently performed procedures. ERC is associated with increased odds of severe postoperative complications when compared to more conservative SFC resections. Nonetheless, all the alternatives seem to provide similar pathologic and long-term outcomes, supporting the oncological safety of more conservative resections for emergency SFCs.

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