The renocolic ligament is connective tissue posteriorly adherent from the colon to the kidney and must be divided to complete the dissection. In laparoscopic surgery, extralong instruments, additional working ports, and changes in patient position may be necessary.ĭorsally, attachments to the kidney and filmy adhesions to the tail of the pancreas must be freed to supply adequate mobilization of the splenic flexure. A low-lying, nonredundant flexure is much easier to mobilize than a high, redundant colon that is closely adherent to the spleen.įor difficult splenic flexures in open surgery, the incision must be of adequate size to provide optimal lighting and retraction. Variation in the splenic flexure redundancy, angle, and location can greatly affect the difficulty in mobilization. Aggressive downward traction on the flexure can cause avulsion injury to the splenic capsule, resulting in dangerous bleeding that may rarely require splenectomy. The dissection continues from distal to proximal on the descending colon in the proper plane along the white line of Toldt, as appropriate medial traction is applied. The anatomic relations of the splenic flexure in situ are shown in Figure 23-1, B and C. The splenocolic (lienocolic) ligament is the superior extension of this and forms connective bands connecting the apex of the splenic flexure to the inferior aspect of the splenic capsule. To mobilize the splenic flexure, the avascular lateral attachments of the descending colon to the retroperitoneum must be divided along the white line of Toldt. The type of surgery offered to patients with this malignancy should be dependent on patient factors and surgeon preference.The splenic (or left) flexure of the colon is the bend in the bowel where the distal transverse colon transitions to the descending colon. Lymph node clearance is statistically better but not clinically significant in a formal oncologic resection. LVI, resection margins, mortality, survival, and recurrence are comparable when compared to formal oncologic resection. Conclusion: Segmental splenic flexure resection outcomes are similar to anatomical/oncologic resection, making it a good option for the treatment of splenic flexure carcinoma. On Cox multivariable analysis, age (HR 1.07 1.04-1.09, p=<0.001), and tumor stage (p=<0.001) were found to be significant factors affecting mortality, as expected. ![]() Arm B patients were treated either with more limited resections (resection of the TC and of the SF) or with extended. No difference was identified in overall (p=0.12), 30 day (p=0.27) or 90 day mortality (p=0.32), overall survival (p=0.83), disease free survival (p=0.83) and overall recurrence (p=0.20). Based on tumor location, patients were enrolled in arm A (cancer of the ascending colon, right (hepatic) flexure, left and sigmoid colon) or arm B (cancer of. Lymphovascular invasion (LVI) and resection margins were comparable but OR had better mean lymph node clearance (17.6 vs 14.7, p=0.0047). Most tumors overall were stage 2 and moderately differentiated although there was no difference between the two surgical groups. Overall, 88% underwent primary anastomosis whereas 11% required either a colostomy or diverting loop ileostomy. The rest had urgent/emergent surgery for obstruction or perforation. For both groups, 77% of the operations were performed electively. There were no differences in age, gender, or race. Results: A total of 202 patients were found of which 113 underwent SF and 89 OR. ileocolectomy, enterocolectomy, partial resection of a colonic flexure, X,, X, o. Overall, 30 and 90 day mortality, overall survival, disease free survival, lymph node clearance and disease recurrence were compared. Includes cryosurgery, fulguration, laser surgery (vaporization). Patients were stratified into segmental splenic flexure resection and anatomical/oncologic resection (extended right, left and subtotal colectomy) groups. Methods: A retrospective review of patients with newly diagnosed splenic flexure carcinoma from the year 1993 to 2015 was performed. The purpose of this study was to compare short and long-term outcomes of segmental splenic flexure resection (SF) versus anatomical/oncologic resection (OR) in patients with splenic flexure adenocarcinoma. ![]() Hangge 1, Matthew Neville 3, Scott Kelley 4, Tonia Young-Fadok 2, Etzioni David 2, Nitin Mishra 2ġDepartment of General Surgery, Mayo Clinic Arizona, Phoenix, AZ 2Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Phoenix, AZ 3Department of Research and Biostatistics, Mayo Clinic Arizona, Phoenix, AZ 4Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MNīackground: The optimal surgical resection for colon cancer of the splenic flexure is controversial. SHORT AND LONG-TERM OUTCOMES OF PATIENTS WITH COLON CANCER OF THE SPLENIC FLEXURE: A SINGLE INSTITUTION EXPERIENCEĮsteban Calderon * 1, Shreya Shetty 2, Patrick T.
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