Nicola de'Angelis1,2, Eloy Espin3, Frederic Ris4, Filippo Landi5, Bertrand Le Roy6, Federico Coccolini7, Valerio Celentano8,9, Angela Gurrado10, Denis Pezet6, Giorgio Bianchi1, Riccardo Memeo11, Giulio C Vitali4, Alejandro Solis3, Christine Denet12, Salomone Di Saverio13, Gian Luigi de'Angelis14, Miquel Kraft3, Paula Gonzálvez-Guardiola15, Aine Stakelum16, Fausto Catena17, David Fuks12, Des C Winter16, Mario Testini10, Aleix Martínez-Pérez1. 1. Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy. 2. University of Paris Est, UPEC, Créteil, France. 3. Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain. 4. Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland. 5. Department of General Surgery, Viladecans Hospital, Barcelona, Spain. 6. Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France. 7. General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy. 8. Minimally Invasive Colorectal Unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK. 9. University of Portsmouth, Portsmouth, UK. 10. Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy. 11. Unit of HPB and Emergency Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy. 12. Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France. 13. Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK. 14. Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy. gianluigi.deangelis@unipr.it. 15. Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain. 16. Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. 17. Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.
Abstract
BACKGROUND: The 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. METHOD: This 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. RESULTS: 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%). 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. CONCLUSION: In 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.
BACKGROUND: The 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. METHOD: This 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. RESULTS: 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%). 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. CONCLUSION: In 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.
Authors: G Manceau; S Benoist; Y Panis; A Rault; M Mathonnet; D Goere; J J Tuech; D Collet; C Penna; M Karoui Journal: Tech Coloproctol Date: 2020-01-14 Impact factor: 3.781
Authors: Irshad A Shaikh; Stuart A Suttie; Mary Urquhart; Amin I Amin; Thomas Daniel; Satheesh Yalamarthi Journal: Int J Colorectal Dis Date: 2011-08-18 Impact factor: 2.571
Authors: G Gravante; M Elshaer; R Parker; A C Mogekwu; B Drake; A Aboelkassem; E U Rahman; R Sorge; T Alhammali; K Gardiner; S Al-Hamali; M Rashed; A Kelkar; R Agarwal; S El-Rabaa Journal: Ann R Coll Surg Engl Date: 2016-03-29 Impact factor: 1.891