Segmental Versus Extended Resection for Splenic Flexure Colon Cancer: A Comparative Outcome Analysis

Abstract

Splenic flexure colon cancer accounts for 2–8% of all colorectal malignancies and presents unique surgical challenges due to variable blood supply and lymphatic drainage. The optimal extent of surgical resection remains controversial, with options including segmental colonic resection and extended hemicolectomy (right or left). This study compares perioperative and short-term oncological outcomes between these two approaches. A prospective comparative study was conducted at Tobruk Medical Center, Libya, from January 2022 to December 2023. A total of 50 patients with splenic flexure colon cancer were enrolled and divided into two equal groups: Group 1 (Segmental Colonic Resection, n=25) and Group 2 (Extended Hemicolectomy, n=25). Exclusion criteria included distant metastases, synchronous tumors, R1 resection, colonic polyposis, benign lesions, and emergency surgery. Outcome measures included operative time, postoperative complications (Clavien-Dindo classification), lymph node harvest, hospital stay, and 30-day mortality. Statistical analysis employed Student's t-test for continuous variables and Chi-square test for categorical variables, with significance defined as p<0.05. No statistically significant differences were observed between the two groups regarding age, gender, ASA score, comorbidities, operative time (195.8±58.7 vs. 210.2±71.6 minutes, p=0.44), laparoscopy/laparotomy rates, postoperative complications (24% vs. 16%, p=0.47), hospital stay (13.5±12.4 vs. 14.9±11.8 days, p=0.673), or 30-day mortality (4% vs. 0%, p=0.31). Elective surgery was significantly more common in the segmental group (92% vs. 48%, p<0.0001). Extended hemicolectomy yielded significantly higher lymph node harvest (18.3±8.7 vs. 13±5.7 nodes, p=0.01) and a greater proportion of patients achieving ≥12 lymph nodes (96% vs. 60%, p=0.002). However, no significant differences were found in T category (p=0.44), N category (p=0.39), or overall stage distribution (p=0.54) between the two groups. Segmental colonic resection and extended hemicolectomy demonstrate comparable perioperative outcomes, complication rates, hospital stay, and short-term oncologic staging for patients with splenic flexure colon cancer undergoing elective surgery. Although extended hemicolectomy provides superior lymph node harvest, this does not translate into improved nodal staging or stage distribution. Segmental resection represents a safe and effective alternative that preserves bowel length and may reduce surgical extent without compromising oncologic safety. A risk-stratified, individualized surgical approach is recommended based on tumor stage, patient factors, and intraoperative findings.