Comparative study of left and enlarged right hemicolectomy for patients with colonic splenic flexure

doi:10.3877/cma.j.issn.1674-0793.2018.03.004

Abstract

Abstract:

Objective

To compare the curative effect of left hemicolectomy (LC) and enlargement of right hemicolectomy (RC) for splenic flexure tumors of colon.

Methods

From October 2010 to October 2012, a retrospective analysis of ninety patients with colon splenic tumors undergoing surgery in the Seventh People’s Hospital of Chengdu was performed. Among them, 42 patients underwent LC surgery and 48 patients underwent RC surgery. The correlation between operation and postoperative indicators, postoperative complications and long-term survival status, the changes of serum IL-6, IL-10 and IFN-γ in patients before and after operation were detected by ELISA method.

Results

There were no significant differences in R0 resection rate, mortality, operative time, bleeding, the number of lymph nodes, postoperative exhaust time, hospitalization stay and reoperation between the two groups. The rate of complication was 16.67% in group LC and 18.75% in group RC, the difference was not statistically significant. The serum levels of IL-10 and IL-6 in the two groups were significantly lower than those before the operation and the levels of IFN-γ were significantly higher (P<0.05). The average survival period and 1-, 3- year survival rate of RC group were higher than those of LC group, the differences were statistically significant (Log-rank=12.027, 13.491; P=0.038, 0.014).

Conclusions

The long-term effect of RC surgery is slightly better than that of LC operation for patients with colonic splenic flexure. Preoperative evaluation of lymph node circumfluence and tumor blood supply can be more favorable for patients to choose suitable operation mode.

Key words: Colonic neoplasms, Colectomy, Splenic flexure, Comparative effectiveness research

Lei Shi, Wei Yong, Shu Yan. Comparative study of left and enlarged right hemicolectomy for patients with colonic splenic flexure[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(03): 170-173.

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References 18

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组别	例数	年龄（岁，±s）	男/女（例）	TNM分期（例）			分化程度（例）
组别	例数	年龄（岁，±s）	男/女（例）	Ⅱ	Ⅲ	Ⅳ	低	中	高
LC组	42	67.18±9.17	26/16	17	22	3	13	20	9
RC组	48	68.84±8.25	31/17	19	24	5	16	21	11
统计值		t=1.073	χ²=2.179	χ²=0.963			χ²=1.332
P值		>0.05	>0.05	>0.05			>0.05

组别	例数	年龄（岁，±s）	男/女（例）	TNM分期（例）			分化程度（例）
组别	例数	年龄（岁，±s）	男/女（例）	Ⅱ	Ⅲ	Ⅳ	低	中	高
LC组	42	67.18±9.17	26/16	17	22	3	13	20	9
RC组	48	68.84±8.25	31/17	19	24	5	16	21	11
统计值		t=1.073	χ²=2.179	χ²=0.963			χ²=1.332
P值		>0.05	>0.05	>0.05			>0.05

组别	例数	R0切除率[例(%)]	手术死亡率[例(%)]	手术时间^a（min）	术中出血量^a（ml）	淋巴结清扫数^a（个）	术后排气时间^a（h）	住院时间^a（d）	阳性淋巴结^a（个）	二次手术[例(%)]
LC组	42	34（80.95）	1（2.38）	156.29±20.17	80.32±15.63	14.39±5.05	79.32±13.51	14.83±2.94	1.73±0.42	2（4.76）
RC组	48	39（81.25）	2（4.17）	152.09±22.15	78.39±16.24	15.72±5.31	81.16±12.62	15.03±2.51	1.67±0.39	3（6.25）
统计值		χ²=0.001	χ²=2.115	t=0.935	t=0.572	t=1.213	t=0.668	t=0.348	t=2.224	χ²=0.095
P值		0.971	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	0.758

组别	例数	R0切除率[例(%)]	手术死亡率[例(%)]	手术时间^a（min）	术中出血量^a（ml）	淋巴结清扫数^a（个）	术后排气时间^a（h）	住院时间^a（d）	阳性淋巴结^a（个）	二次手术[例(%)]
LC组	42	34（80.95）	1（2.38）	156.29±20.17	80.32±15.63	14.39±5.05	79.32±13.51	14.83±2.94	1.73±0.42	2（4.76）
RC组	48	39（81.25）	2（4.17）	152.09±22.15	78.39±16.24	15.72±5.31	81.16±12.62	15.03±2.51	1.67±0.39	3（6.25）
统计值		χ²=0.001	χ²=2.115	t=0.935	t=0.572	t=1.213	t=0.668	t=0.348	t=2.224	χ²=0.095
P值		0.971	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	0.758

组别		IL-10	t值^c	P值^c	IL-6	t值^c	P值^c	IFN-γ	t值^c	P值^c
LC组（42例）			11.868	<0.01		8.799	<0.01		8.582	<0.01
	术前	10.05±1.21			7.04±1.51			8.89±1.58
	术后	7.08±1.08			4.37±1.26			12.37±2.10
RC组（48例）			12.573	<0.01		10.202	<0.01		9.677	<0.01
	术前	10.09±1.18			6.99±1.45			8.91±1.63
	术后	7.15±1.11			4.19±1.23			12.59±2.07
	t值^a,b	0.159, 0.302			0.160, 0.685			0.059, 0.500
	P值^a,b	>0.05, >0.05			>0.05, >0.05			>0.05, >0.05

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