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A population-based analysis of the elective surgical management for non-metastatic splenic flexure cancers, the ongoing question.
Zeid, Ahmed Morales-Cruz, Mariana Almonib, Ahmed Ward, Stephen Thomas
Zeid, Ahmed
Morales-Cruz, Mariana
Almonib, Ahmed
Ward, Stephen Thomas
Abstract
AIM AND BACKGROUND: Malignancies found at the splenic flexure correspond to only 2-4% of all colorectal cancers and no standardised surgical technique exists for its treatment. Our study analyses the surgical and oncological outcomes between Extended Right Hemicolectomy (ERH) and Left Hemicolectomy (LH), the operations commonly performed to resect tumours in this location.
METHODOLOGY: A retrospective cohort study of patients with non metastatic splenic flexure cancer treated between 1997 and 2017 within the NHS in England. The surgical approach was defined through OPCS-4 codes. Patients were divided into two different categories depending on the type of surgery performed (ERH vs LH). A number of post-operative and oncological outcomes were compared.
RESULTS: Around 1 690 of the cases were treated with LH, while 1 992 had an ERH. ERH was performed more commonly in younger patients (p = 0.002) and it was significantly associated with longer hospital stay, more frequent return to theatre (p= <0.0001) and higher 90-day mortality rate (p = 0.0361). The lymph node yield was significantly greater for ERH when compared to LH (p < 0.001) but there were no significant differences in survival (p = 0.877).
CONCLUSIONS: Lymph node yield is greater in ERH compared to LH yet this is not reflected in improved survival. LH appears to have some advantages in terms of improved post-operative outcomes. Important patient outcomes, such as bowel function, could not be measured.
MIDER Authors
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Date
2026-07-21
Type
Article
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Citation
Zeid A, Morales-Cruz M, Almonib A, Ward ST. A population-based analysis of the elective surgical management for non-metastatic splenic flexure cancers, the ongoing question. Cancer Treat Res Commun. 2026 Jul 21;48:101318. doi: 10.1016/j.ctarc.2026.101318. Epub ahead of print. PMID: 42480397.