Surgical management of splenic flexure colonic malignancy

Abstract

There is a lack of consensus on the optimal surgical approach for splenic flexure malignancies. Surgeons face the challenge of balancing successful oncological outcomes with the morbidity and functional effects of extended colonic resection, considering the variable ‘watershed’ vasculature and lymphatic anatomy of the splenic flexure. While there is an increasing body of evidence supporting the oncological safety of a more conservative segmental resection, most of the data stems from retrospective single center studies. This article reviews the management strategies and examines the evidence supporting various surgical approaches to splenic flexure malignancies.

Keywords: Colonic malignancy; Surgical approach; Splenic flexure malignancy; Extended right hemicolectomy; Left hemicolectomy; Segmental resection; Splenic flexure cancer

Core Tip: There are several studies in current literature discussing the optimal surgical approach for splenic flexure malignancies. However, these studies are mainly retrospective and performed in single centers. The variability in the vascular and lymphatic anatomy of the splenic flexure coupled with the lack of international standardization in the terminology for oncologic resections makes management challenging. This article reviews the various management strategies in the literature and examines the evidence supporting various surgical approaches to splenic flexure malignancies.