European multicenter propensity score match study of laparoscopic vs. open colectomy for splenic flexure carcinomas: Results from the Splenic Flexure Cancer (SFC) Study Group - 06/07/21

Doi : 10.1016/j.jviscsurg.2021.06.007

Spenic Flexure Cancer (SFC) Study Group
N. Beghdadi ^a, N. de’Angelis ^a,^⁎ , F. Brunetti ^a, G. Bianchi ^a, J. Pham ^a, P. Genova ^a, I. Sobhani ^a, A. Martínez-Pérez ^b, S.A. Gómez ^b, M.T. Torres ^b, C. Payá ^b, P. Gonzálvez ^b, D.C. Winter ^c, A. Stakelum ^c, A. Zaborowski ^c, F. Landi ^d, A. Sueiras-Gil ^d, R. Hevia ^d, G.C. Vitali ^e, M. Assalino ^e, F. Ris ^e, B. Le Roy ^f, D. Pezet ^f, M. Abdallah ^f, F. Coccolini ^g, L. Ansaloni ^g, V. Celentano ^g, M. Kraft ^h, A. Solis ^h, E. Espin ^h, C. Denet ⁱ, D. Fuks ⁱ, A. Birindelli ^j, S. Di Saverio ^j
^a Digestive and hepato-biliary surgery unit, Henri Mondor Hospital, AP-HP, Paris Est University, UPEC, Créteil, France
^b Colorectal Surgery Unit, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valence, Spain
^c Surgery Department, St. Vincent's University Hospital, ElmPark, Dublin 4, Ireland
^d Department of General Surgery, Viladecans Hospital, Barcelone, Spain
^e Abdominal Surgery Department, Geneva University Hospitals and Medical School, Geneva, Switzerland
^f Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, France
^g Department of General Surgery, Emergency and Traumatology, Bufalini Hospital of Cesena, Italy
^h Colorectal Surgery Unit, Department of General and Digestive Surgery,University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelone, Spain
ⁱ Department of Digestive Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
^j Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, United-Kingdom

^⁎Corresponding author. Digestive and hepato-biliary surgery unit, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.Digestive and hepato-biliary surgery unit, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC51, avenue du Maréchal de Lattre de TassignyCréteil94010France

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Highlights

•	Splenic flexure colon carcinoma (SFC) represent less than 10% of colorectal cancers and they have been excluded from randomized clinical trials comparing laparoscopy to laparotomy.
•	This multicenter European study is based on the largest cohort of patients with SFCC treated by elective curative-intent surgical resection surgical resection.
•	The results show that laparoscopy is associated with operative advantages (less blood loss) and post-operative advantages (faster patient rehabilitation) compared to laparotomy.
•	The benefits of the laparoscopic approach are observed regardless of the type of procedure performed (extended right hemicolectomy, left hemicolectomy or segmental left colectomy).
•	The 5-year overall and recurrence-free survival rates of patients operated on by laparoscopy are comparable to those observed in patients operated on by laparotomy.

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Summary

Aim of the study

This European multicenter study aims to compare the results of laparoscopic versus laparotomy approach for the resection of splenic flexure colon carcinoma (SFC).

Patients and methods

Patients with SFC who required curative resection by laparoscopy (LAP) or laparotomy (OPEN) between 2000 and 2018 were included. Three types of interventions were considered: extended right hemi-colectomy, left hemi-colectomy and splenic flexure resection. The LAP and OPEN groups were matched according to propensity score and compared with Chi-square, Mann-Whitney tests, and multivariate regression models. Overall survival and recurrence-free survival were assessed using the Kaplan-Meier method.

Results

The study population consisted of 399 patients, including 297 operated by LAP and 102 by OPEN. Extended right hemi-colectomy was performed in 35.8% of cases, left hemi-colectomy in 32.8% and splenic flexure resection in 31.4%. After propensity score matching, the LAP (n=64) and OPEN (n=64) groups were comparable for all pre-operative variables and tumor characteristics. The LAP group showed less blood loss and a shorter interval to return of transit and feeding compared to the OPEN group, regardless of the resection technique. There were no differences between the groups in terms of overall survival and 5-year recurrence-free survival.