Surgical management of splenic flexure colonic malignancy

Table 1 Summary of the three surgical approaches for splenic flexure malignancy

Type of surgical approach	Proximal and distal extent for bowel transection	Major vessels ligated	Type of bowel anastomosis	Pros of surgical approach	Cons of surgical approach
Extended right hemicolectomy	Proximal: Terminal ileum; distal: Descending colon or sigmoid colon	Ileocolic; right colic; middle colic; +/- left colic	Ileocolic	(1) High lymph node yield; and (2) Allows for concomitant resection of synchronous tumor or non-viable proximal colon (in setting of obstruction)	(1) Unnecessary resection of excess bowel length; (2) Increased risk of iatrogenic injury; and (3) Possible increased risk of adhesions due to extensive dissection
Left hemicolectomy	Proximal: Mid transverse colon; distal: Rectosigmoid colon	Left branch of middle colic; inferior mesenteric	Colorectal	Allows for concomitant resection of synchronous tumor or non-viable proximal colon (in setting of obstruction)	Technically more demanding to achieve tension free anastomosis
Segmental resection	Proximal: Transverse colon; distal: Descending colon	Left branch of middle colic; left colic	Colo-colic	(1) Avoids unnecessary resection of bowel; and (2) Shorter operative time, shorter length of stay, faster bowel recovery	Risk of inadequate oncological resection