Splenic flexure cancer optimum level of vessel ligation
DOI:
https://doi.org/10.18203/2349-2902.isj20171141Keywords:
Left branch of middle colic artery, Marginal of middle colic artery, Splenic flexure carcinomaAbstract
Background: Incidence of splenic flexure carcinoma is very low in colorectal cancer but often time presented in an advanced stage with high risk of obstruction, contributing poor prognosis. Aim of the study was to investigate the adequacy of vessel ligation in SFC in term of overall survival.
Methods: 35 patients diagnosed with splenic flexure carcinoma enrolled and analyzed, patients categorized based on the level of vessel ligation as group-A, left branch of middle colic (LMA) and left colic artery division (LCA) compared, group-B, LCA and marginal of middle colic artery (MMC).
Results: CEA marker was not significantly changed post-operatively, as it was within normal range preoperatively at an average of 9-12 µg/ml. There is no significance in staging of tumors in all stages, and recurrence of tumor is present in 5 in group A. Radical margins both proximal and distal ends are not significant. Tumor clearance achieved successfully in both arms in term of proximal margin achieved at 7.9±3.5cm in groups B and 8.3±4.1 cm in group A, p = 0.312. Distal margin reported at 8.7±4.1 cm and 8.9±3.98cm, p = 0.58, respectively. Lymph nodes are positive in group-A and group-B without any significance. Tumor size or diameter ranging from 5.1±3.1 in group-A and 4.76±3.8 in group-B. According to the cell differentiation, majority of the tumor grade turned out to be moderately differentiated cancer, rated at 14 patients (40.1%) in group A and 13 patients (37.1%) in group B. one patients found to be well or poorly differentiated cell tumors in group-A. Overall p-values were insignificant in regards tumor cell differentiation in both groups, p = 0.213. Incidence of lympho-vascular invasion reached only 3 (8.5%) vs. 4 patients (11.2%), p = 0.562, in A and B group.
Conclusions: Higher level of vessel ligation has no added significance in overall outcome, but has role to lower the risk of recurrence rate in Splenic flexure carcinoma patients.Metrics
References
Boyle P, Langman JS. ABC of colorectal cancer: epidemiology. BMJ. 2000;321:805-8.
Goh KL, Quek KF, Yeo GT. Colorectal cancer in Asians: a demographic and anatomic survey in Malaysian patients undergoing colonoscopy. Aliment Pharmacol Ther. 2005;22:859-64.
Mohandas KM, Desai DC. Epidemiology of digestive tract cancers in India. V. Large and small bowel. Indian J Gastroenterol. 1999;18:118-21.
Nawa T, Kato J, Kawamoto H, Okada H, Yamamoto H, Kohno H, et al. Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol. 2008;23:418-23.
Glebov OK, Rodriguez LM, Nakahara K, Jenkins J, Cliatt J, Humbyrd CJ, et al. Distinguishing right from left colon by the pattern of gene expression. Cancer Epidemiol Biomarkers Prev. 2003;12:755-62.
Demtroder DK, Olesen SH, Sorensen FB, Laurberg S, Laiho P, Aaltonen LA, et al. Differential gene expression in colon cancer of the caecum versus the sigmoid and rectosigmoid. Gut. 2005;54:374-84.
Meguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N. Is there a difference in survival between right-versus left-sided colon cancers? Ann Surg Oncol. 2008;15:2388-94.
Aldridge MC, Phillips RK, Hittinger R, Fry JS, Fielding LP. Influence of tumour site on presentation, management and subsequent outcome in large bowel cancer. Br J Surg. 1986;73:663-70.
Sadler GP, Gupta R, Foster ME. Carcinoma of the splenic flexure a case for extended right hemicolectomy? Postgrad Med J. 1992;68:487.
Steffen CE, Bokey L, Chapuis PH. Carcinoma of the splenic flexure. Dis Colon Rectum. 1987;30:872-4.
Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum. 1995;38:705-11.
Ceccarelli G, Biancafarina A, Patriti A, Spaziani A, Bartoli A, Bellochi R, et al. Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure. Surg Endosc. 2010;24:1784-8.
Walfisch S, Stern H. Use of thoracoabdominal incision for cancer of the splenic flexure in the obese patient. Dis Colon Rectum. 1989;32:169-70.
Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y. Japanese society for cancer of the colon and rectum (Jsccr) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1-29.
Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994;81:1224-6.
Hall NR, Finan PJ, Stephenson BM, Lowndes RH, Young HL. High tie of the inferior mesenteric artery in distal colorectal resections a safe vascular procedure. Int J Colorectal Dis. 1995;10:29-32.
Hallbook O, Johansson K, Sjodahl R. Laser doppler blood flow measurement in rectal resection for carcinoma comparison between the straight and colonic pouch reconstruction. Br J Surg. 1996;83:389-92.
Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, Connell PR. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum. 2007;50:302-7.
Downloads
Published
How to Cite
Issue
Section
