Propensity score analysis of postoperative and oncological outcomes
after surgical treatment for splenic flexure colon cancer
J. Martín Arévalo
S. A. García-Botello
L. Pérez Santiago
Accepted: 24 April 2018 / Published online: 29 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose The surgical treatment of splenic flexure colon cancer (SFCC) is somehow not yet well standardized. Postoperative and
oncological results of the three surgical techniques most commonly used to treat SFCC: extended right colectomy (ERC),
egmental left colectomy (SLC), and left colectomy (LC) were evaluated.
Methods The study included all patients with stage I-III SFCC treated by ERC, SLC, or LC between 2005 and 2016.
Postoperative and long-term outcomes after the different surgical techniques were analyzed: Propensity score matching (PSM)
was performed to compare the outcomes between these surgical techniques and survival analyses were performed using the
Kaplan-Meier method and log-rank tests.
Results A total of 170 SFCC patients were operated; ERC was performed in 71 (41.76%), SLC in 36 (21.18%), and LC
in 63 (37.06%). There were no significant differences in the short and long-term postoperative outcomes. Three com-
parison groups were developed so that PSM could be performed between the surgical technique cases: ERC (n =59)vs.
LC (n =50);ERC(n =50)vs.SLC(n = 33); and SLC (n =32)vs.LC(n = 44). No differences in the short or long-term
outcomes of these techniques were observed.
Conclusion The short and long-term outcomes between ERC, SLC, and LC are similar. SLC should be considered oncologically
as appropiate as the other more extensive resections.
Keywords Segmental left colectomy
The splenic flexure of the colon is not a common location of
primary tumors in patients with a diagnosis of colon cancer.
However, some studies have associated cancer at this tumoral
site with a worse prognosis and an increased risk of bowel
obstruction [1–3], although the results of recent studies seem
to discuss this statement . Experience with splenic flexure
colon cancers (SFCCs) is very limited because they account
for only 2–8% of all colon cancer cases ; this implies that an
average colorectal surgery unit probably performs from 5 to
12 SFCC resections per year. Thus, there is still no agreement
on the most appropriate surgical technique for the treatment of
these tumors .
Conventional techniques for treating SFCC include ex-
tended right colectomy (ERC), also known as subtotal
colectomy, and left colectomy (LC), which is occasionally
associated with distal pancreatosplenectomy. There is also
some confusion in the literature regarding the definition of
LC and segmental left colectomy (SLC), which are some-
times used as interchangeable terms. Conceptually, SLC is
defined as a resection of the colonic segment between the
left branch of the middle colic artery and the left colic
artery with a subsequent anastomosis [6–13], whereas LC
implies a resection of the colon between the left branch of
the middle colic artery and the inferior mesenteric artery
with a colorectal anastomosis [6, 14–16].
The increased use of laparoscopic approaches over the last
10 years has favored the emergence of several series reporting
the experience with SLC using this technique to surgically
* J. Martín Arévalo
Department of Surgery, University of Valencia, Valencia, Spain
Department of Surgery, Hospital Clínico Universitario de Valencia,
Avda. Blasco Ibañez 17, 46010 Valencia, Spain
International Journal of Colorectal Disease (2018) 33:1201–1213