Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN)

被引：5

作者：

Degiuli, Maurizio ^{[1
,37
]}

Ortenzi, Monica ^{[2
]}

Tomatis, Mariano ^{[3
]}

Puca, Lucia ^{[1
]}

Cianflocca, Desiree ^{[4
,5
]}

Rega, Daniela ^{[6
]}

Maroli, Annalisa ^{[7
]}

Elmore, Ugo ^{[8
]}

Pecchini, Francesca ^{[9
]}

Milone, Marco ^{[10
]}

La Mendola, Roberta ^{[11
]}

Soligo, Erica ^{[12
]}

Deidda, Simona ^{[13
]}

Spoletini, Domenico ^{[14
]}

Cassini, Diletta ^{[15
]}

Aprile, Alessandra ^{[16
]}

Mineccia, Michela ^{[17
]}

Nikaj, Herald ^{[18
]}

Marchegiani, Francesco ^{[19
]}

Maiello, Fabio ^{[20
]}

Bombardini, Cristina ^{[1
]}

Zuolo, Michele ^{[22
]}

Carlucci, Michele ^{[23
]}

Ferraro, Luca ^{[24
]}

Falato, Armando ^{[25
]}

Biondi, Alberto ^{[26
]}

Persiani, Roberto ^{[26
]}

Marsanich, Patrizia ^{[27
]}

Fusario, Daniele ^{[28
]}

Solaini, Leonardo ^{[29
]}

Pollesel, Sara ^{[30
]}

Rizzo, Gianluca ^{[30
]}

Coco, Claudio ^{[30
]}

Di Leo, Alberto ^{[31
]}

Cavaliere, Davide ^{[33
]}

Roviello, Franco ^{[30
]}

Muratore, Andrea ^{[27
]}

D'Ugo, Domenico ^{[26
]}

Bianco, Francesco ^{[25
]}

Bianchi, Paolo Pietro ^{[24
,32
]}

De Nardi, Paola ^{[24
]}

Rigamonti, Marco ^{[22
]}

Anania, Gabriele ^{[21
]}

Belluco, Claudio ^{[33
]}

Polastri, Roberto ^{[20
]}

Pucciarelli, Salvatore ^{[19
]}

Gentilli, Sergio ^{[18
]}

Ferrero, Alessandro ^{[17
]}

Scabini, Stefano ^{[16
]}

Baldazzi, Gianandrea ^{[15
]}

机构：

[1] Univ Turin, San Luigi Univ Hosp, Dept Oncol, Div Surg Oncol, Turin, Italy

[2] Clin Chirurg Univ Politecn Marche, Osped Riuniti, Ancona, Italy

[3] Univ Turin, Dept Oncol, BSIT, Turin, Italy

[4] S Croce & Carle Hosp, Dept Surg, Cuneo, Italy

[5] Azienda Osped Univ, Dept Gen & Emergency Surg, Citta Salute & Sci, Turin, Italy

[6] Fdn Giovanni Pascale IRCCS, Abdominal Oncol Dept, Colorectal Surg Oncol, Naples, Italy

[7] Humanitas Clin & Res Ctr, Colon & Rectal Surg Div, Via Alessandro Manzoni 56, I-20089 Milan, Italy

[8] Univ Vita Salute San Raffaele, San Raffaele Hosp, Div Gastrointestinal Surg, I-20132 Milan, Italy

[9] Azienda Osped Univ Modena, Unita Operat Chirurg Gen Urgenza & Nuove Tecnol, OCSAE, Modena, Italy

[10] Univ Naples Federico II, Dept Clin Med & Surg, Dept Gastroenterol Endocrinol & Endoscop Surg, Naples, Italy

[11] Santa Maria Misericordia Hosp, Gen Surg Unit, Rovigo, Italy

[12] Osped S Andrea Vercelli, SC Chirurg Gen, Vercelli, Italy

[13] Univ Cagliari, Dipartimento Sci Chirurg, Chirurg Coloproctol AOU Cagliari, Cagliari, Italy

[14] Osped S Eugenio, UOC Chirurg Gen, Piazzale Umanesimo 10, I-00144 Rome, Italy

[15] ASST NORD MILANO, Unita Operat Complessa Chirurg Gen, PO SSG, Milan, Italy

[16] IRCCS Policlin San Martino, Surg Oncol Surg, Genoa, Italy

[17] Umberto I Mauriziano Hosp, Dept Gen & Oncol Surg, Turin, Italy

[18] AOU Maggiore Carita Hosp, Gen Surg Dept, SCDU Clin Chirurg, Novara, Italy

[19] Univ Padua, Dept Surg Oncol & Gastroenterol Sci, Padua, Italy

[20] Hosp Biella, Dept Surg, Gen Surg Unit, Biella, Italy

[21] AOU Ferrara, Dept Surg Morphol & Expt Med, Ferrara, Italy

[22] Valli Noce Hosp, Prov Agcy Hlth Serv APSS, Gen Surg Div, Trento, Italy

[23] Osped San Raffaele, Gastrointestinal Surg, I-20132 Milan, Italy

[24] Univ Milan, Div Gen & Robot Surg, Dipartimento Sci Salute, I-20142 Milan, Italy

[25] ASL NA3sud, Gen Surg Unit, San Leonardo Hosp, Naples, Italy

[26] Fdn Policlin Gemelli, Area Chirurg Addominale, IRCCS, Rome, Italy

[27] Edoardo Agnelli Hosp, Surg Dept, Pinerolo, Italy

[28] Univ Siena, UOC Gen & Oncol Surg, Siena, Italy

[29] Ausl Romagna, Gen & Oncol Surg, Morgagni Pierantoni Hosp, Forli, Italy

[30] Fdn Policlin Univ Gemelli, Chirurg Gen Presidio Columbus, IRCCS, Rome, Italy

[31] Osped San Camillo, UOC Chirurg, Trento, Italy

[32] Misericordia Hosp, Dept Surg, Grosseto, Italy

[33] Natl Canc Inst, Dept Surg Oncol, IRCCS, CRO Aviano, Aviano, Italy

[34] Humanitas Clin & Res Ctr, Via Alessandro Manzoni 56, I-20089 Milan, Italy

[35] Humanitas Univ, Dept Biomed Sci, Milan, Italy

[36] Candiolo Canc Inst FPO IRCCS, Oncol Surg, I-10060 Turin, Italy

[37] Univ Torino, San Luigi Univ Hosp, Dept Oncol Head Surg Oncol & Digest Surg, Reg Gonzole 10 Orbassano, I-10043 Turin, Italy

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2023年 / 37卷 / 02期

关键词：

Splenic flexure cancer; Minimally invasive surgery; Open surgery; Colon cancer; Segmental resection; Laparoscopic resection; EXTENDED RIGHT COLECTOMY; COLON-CANCER; LAPAROSCOPIC SURGERY; CLINICOPATHOLOGICAL CHARACTERISTICS; MICROSATELLITE INSTABILITY; SURVIVAL OUTCOMES; CLASICC TRIAL; CARCINOMA; MULTICENTER; DIFFICULTY;

D O I：

10.1007/s00464-022-09547-6

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. Methods This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed >= 12, and proximal and distal free resection margins length >= 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. Results A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to infinity). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to infinity). Conclusions Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.

引用

页码：977 / 988

页数：12

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