Background: While carcinoma of the splenic flexure is uncommon, it is associated with a high risk of obstruction and a poor prognosis. The aim of this study was to evaluate the prognostic factors for recurrence and survival after surgery for carcinoma of the splenic flexure.
Methods: Between March 1986 and September 2007, a total of 2987 patients with colorectal carcinoma underwent surgery at our institution, of whom 61 (2%) had carcinoma of the splenic flexure. The clinicopathological factors possibly predicting survival among these 61 patients were retrospectively reviewed. Survival was calculated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using Cox’s regression model.
Results: Forty-five patients (73.8%) underwent curative surgery (leaving no residual or metastatic disease). Thirty-five patients (57.4%) presented with intestinal obstruction and underwent emergency surgery. Multivisceral resections were needed in 14 patients (23%). Postoperative morbidity and mortality developed in 26 (42.6%) and 6 (9.8%) patients, respectively. Among patients surviving surgery, the cancer-specific survival at 5 years was 47.1%. Postoperative morbidity (P=0.016), T4 tumour (P<0.001), and non-curative surgery (P<0.001) were found to be independent prognostic factors for poor cancer-specific survival. Thirteen patients developed recurrence after curative surgery, and the probability of being disease free at 5 years was 62%. Postoperative morbidity (P=0.020) and T4 tumour (P<0.001) were found to be independent predictors for recurrence. Intestinal obstruction and surgical approach were not predictors for poor survival.
Conclusion: In addition to curative surgery, T stage of tumour and postoperative morbidity are found to be independent prognostic factors for survival after surgery for carcinoma of the splenic flexure.