Ann Surg Treat Res.  2017 Jul;93(1):35-42. 10.4174/astr.2017.93.1.35.

Long-term oncologic outcomes of laparoscopic surgery for splenic flexure colon cancer are comparable to conventional open surgery

• Kim MK
• Lee IK
• Kang WK
• Cho HM
• Kye BH
• Jalloun HE
• Kim JG

• KMID: 2392281
• DOI: http://doi.org/10.4174/astr.2017.93.1.35

Abstract

PURPOSE
Few studies about laparoscopic surgery for splenic flexure colon cancer have been published. This study aims to compare the short- and long-term outcomes of laparoscopic surgery for splenic flexure colon cancer with those of conventional open surgery.
METHODS
From January 2004 to December 2010, 51 consecutive patients who underwent curative resection for stages I-III splenic flexure colon cancer were enrolled. Thirty-three patients underwent laparoscopy-assisted colectomy, while 18 patients underwent conventional open colectomy. Short- and long-term outcomes of the 2 groups were compared.
RESULTS
There were no differences in baseline characteristics, intra- and postoperative complications. The laparoscopy group showed longer operation time (median [interquartile range, IQR]: 295.0 [255.0-362.5] minutes vs. 180.0 [168.8-206.3] minutes, P < 0.001). In the laparoscopy group, return of bowel function was faster (median [IQR]: 3 [2-4] vs. 4 [3-5], P = 0.007) and postoperative hospital stay was shorter (median [IQR]: 9 [8-11] vs. 10.5 [9-19], P = 0.026). There were no statistically significant differences in overall survival rate (84.3% vs. 76.0%, P = 0.560) or disease-free survival rate (93.8% vs. 74.5%, P = 0.078) between the 2 groups.
CONCLUSION
Laparoscopic surgery for splenic flexure colon cancer has better short-term outcomes than open surgery, as well as acceptable long-term outcomes. Laparoscopic surgery can be a safe and feasible alternative to conventional open surgery for splenic flexure colon cancer.

Keyword

Laparoscopy; Colonic neoplasms; Treatment outcome; Transverse colon

Figure

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  Fig. 1 (A) Descriptive pictures of the operative procedure. (A) Left colic artery (LCA) was identified and skeletonized before being ligated at its origin. (B) Left branch of the middle colic artery (MCA) was identified and clipped before division. (C) Laparoscopic view after finishing splenic flexure mobilization. (D) Specimen of colon after laparoscopic left hemicolectomy. Preoperative tattooing and clipping were done for this specific patient. IMV, inferior mesenteric vein; IMA, inferior mesenteric artery; MCV, middle colic vein.

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  Fig. 2 Cummulative survival of stages I–III splenic flexure colon cancer patients. There is no significant difference between the laparoscopy-assisted colectomy, (LAC; n = 33) and open colectomy (OC; n = 18) groups. (A) Cummulative 5-year overall survival (OS) rate (84.3% vs. 76.0%, P = 0.560). (B) Cummulative 5-year disease-free survival (DFS) rate (93.8% vs. 74.5%, P = 0.078).

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