Sistema de Salut de Catalunya
Institut Català de la Salut
[de'Angelis N] Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy. University of Paris Est, UPEC, Créteil, France. [Espin E, Solis A, Kraft M] Unitat de Cirurgia de Còlon i Recte, Servei de Cirurgia General i Digestiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Ris F] Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland. [Landi F] Department of General Surgery, Viladecans Hospital, Barcelona, Spain. [Le Roy B] Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France. [Coccolini F] General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
Vall d'Hebron Barcelona Hospital Campus
2021-12-28T10:25:21Z
2021-12-28T10:25:21Z
2021-04-29
Colectomía; Mortalidad; Carcinoma del ángulo esplénico
Colectomia; Mortalitat; Carcinoma de l'angle esplènic
Colectomy; Mortality; Splenic flexure carcinoma
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.
No authors received funding or resources in relation to this article.
Article
Published version
English
Còlon - Càncer - Cirurgia; Avaluació de resultats (Assistència sanitària); DISEASES::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Gastrointestinal Neoplasms::Intestinal Neoplasms::Colorectal Neoplasms::Colonic Neoplasms; Other subheadings::Other subheadings::Other subheadings::/surgery; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Digestive System Surgical Procedures::Colectomy; HEALTH CARE::Health Services Administration::Quality of Health Care::Outcome and Process Assessment (Health Care)::Outcome Assessment (Health Care)::Treatment Outcome; ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias gastrointestinales::neoplasias intestinales::neoplasias colorrectales::neoplasias del colon; Otros calificadores::Otros calificadores::Otros calificadores::/cirugía; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo::colectomía; ATENCIÓN DE SALUD::administración de los servicios de salud::calidad de la atención sanitaria::evaluación de resultados y procesos (atención a la salud)::evaluación del desenlace (asistencia sanitaria)::resultado del tratamiento
BMC
World Journal of Emergency Surgery;16
https://doi.org/10.1186/s13017-021-00365-0
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - HVH [3439]
