Clinical-Pathologic Characteristics and Long-term Outcomes of Left Flexure Colonic Cancer: A Retrospective Analysis of an International Multicenter Cohort

BACKGROUND: Colorectal cancer seldom presents at the splenic flexure. Small series on left flexure tumors reported a high occurrence of negative prognostic factors called into question as causes of poor prognosis. However, because of the small number of cases, no definite conclusions can be drawn.OBJECTIVE: The aim of this study was to compare clinical-pathologic characteristics and short- and long-term outcomes of left flexure tumors with other colonic locations.DESIGN: This was a retrospective analysis of consecutive patients who underwent surgery for tumors at the splenic flexure. Each tumor was paired in a 1 to 1 fashion with a right-sided and sigmoid tumor.SETTINGS: The study was conducted in 10 international centers.PATIENTS: A total of 641 patients with left flexure tumors were included in the study.MAIN OUTCOME MEASURES: Overall survival and cancer-specific survival were measured.RESULTS: Left flexure tumors presented more frequently with stenosis (30.5%; p < 0.001), with lesions infiltrating beyond the serosa (21.9%; p = 0.001) and with a high rate of mucinous histology (8.8%; p = 0.001). Looking at long-term prognosis, no differences were observed among the 3 groups, both considering overall and cancer-specific survival. However, left flexure tumors recurred more frequently as peritoneal carcinomatosis (20.6%; p < 0.001).LIMITATIONS: This study was limited because of its retrospective nature.CONCLUSIONS: Although left flexure tumors display several negative prognostic factors, they are not characterized by a worse prognosis compared with other colon cancer locations. See Video Abstract at http://links.lww.com/DCR/B395. CARACTERISTICAS CLINICO-PATOLOGICAS Y RESULTADOS A LARGO PLAZO DEL CANCER DE COLON DE ANGULO IZQUIERDO: UN ANALISIS RETROSPECTIVO DE UNA COHORTE MULTICENTRICA INTERNACIONAL: El cancer colorrectal rara vez se presenta en el angulo esplenico. Pequenas series sobre tumores de angulo izquierdo informaron una alta incidencia de factores pronosticos negativos cuestionados como causas de mal pronostico. Sin embargo, debido al pequeno numero de casos, no se pueden sacar conclusiones definitivas.El objetivo de este estudio fue comparar las caracteristicas clinico-patologicas, los resultados a corto y largo plazo de los tumores de angulo izquierdo con otras ubicaciones de colon.Analisis retrospectivo de pacientes consecutivos que se sometieron a cirugia por tumores en el angulo esplenico. Cada tumor se emparejo de forma individual con un tumor del lado derecho y sigmoide.El estudio se realizo en 10 centros internacionales.Se incluyeron en el estudio un total de 641 pacientes con tumores del angulo izquierdo.Supervivencia general y especifica del cancerLos tumores de angulo izquierda se presentaron con mayor frecuencia con estenosis (30.5%, p <0.001), con lesiones infiltradas mas alla de la serosa (21.9%, p = 0.001), y con una alta tasa de histologia mucinosa (8.8%, p = 0.001). En cuanto al pronostico a largo plazo, no se observaron diferencias entre los tres grupos, considerando la supervivencia general y especifica del cancer. Sin embargo, los tumores de angulo izquierdo recurrieron con mayor frecuencia como carcinomatosis peritoneal (20,6%; p <0,001).Este estudio fue limitado debido a su naturaleza retrospectiva.Aunque los tumores de angulo izquierdo muestran varios factores pronosticos negativos, no se caracterizan por un peor pronostico en comparacion con otras ubicaciones de cancer de colon. Consulte Video Resumen en http://links.lww.com/DCR/B395.