Surgical Outcomes in Splenic Flexure Cancers: A Prospective, Multicentric Observational Cohort Study Comparing Segmental Hemicolectomy and Extended Hemicolectomy - The SPARROW Study
Conditions: Colon Cancer, Splenic Flexure Mobilization, Right Hemicolectomy, Left Hemicolectomy, Segmental Colectomy, Extended Hemicolectomy
Sponsor: Acibadem University

 
 
 
 
 
 
 
 
 
 
 
 
Study Protocol Version #6 
02/01/2025  
 
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Surgical Outcomes in SPlenic Flexure CAnceRs:  
A CompaRison of Segmental Hemicolectomy vs. Extended HemicolectOmy,  
and KnoWledge Assessment 
 
Prospective, Multicentric Observational Cohort Study 

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TABLE OF CONTENTS 
Table of Contents  
 
 
 
 
 
 
 
 
 
          1 
Abstract 
 
 
 
 
 
 
 
 
 
 
          2 
Steering Committee  
 
 
 
 
 
 
 
 
          3  
External Advisory Board 
 
 
 
 
 
 
 
 
          3 
Background Information & Rationale 
 
 
 
 
 
 
          4 
Audit Standarts  
 
 
 
 
 
 
 
 
 
          5 
Methods 
 
 
 
 
 
 
 
 
 
   
          6 
1. Summary 
 
 
 
 
 
 
 
 
          6  
2. Study Aims 
 
 
 
 
 
 
 
 
          6 
3. Project Timeline 
 
 
 
 
 
 
 
          7 
4. Ethics Approval  
 
 
 
 
 
 
                      7 
5. Centre Eligibility  
 
 
 
 
 
 
 
          8 
6. Patient Eligibility 
 
 
 
 
 
 
 
          9 
a. Inclusion Criteria 
 
 
 
 
 
 
         
b. Exclusion Criteria    
  
  
 
 
 
         
7. Data Governance  
 
   
  
   
  
  
    
  10-11 
a. Sample size considerations 
b. Data Recording 
c. Statistical Analysis 
8. Variable of Interests  
  
  
  
 
  
    
  11-12 
9. Authorship 
 
 
 
 
 
 
 
 
        13 
Appendix A: Study Definitions  
  
  
  
  
   
   
  
  14-16 
References  
  
 
   
  
 
  
  
  
   
   
  17-20 
 
 

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ABSTRACT 
Background 
Colonic cancers arising at the splenic flexure are rare, representing less than 10% of all 
surgically treated colorectal cancers. The optimal surgical approach for these cancers remains a 
subject of debate, with extended colectomy and segmental colectomy being the two primary 
options; however, no prospective multicentre study has yet been conducted. 
Methods 
This prospective, multicenter observational cohort study aims to compare the surgical 
outcomes of extended colectomy and segmental colectomy in patients with splenic flexure 
cancers. A total of 140 patients (70 per group) will be recruited from centers. Primary outcomes 
will include short-term perioperative metrics such as ileus, anastomotic leakage, wound infection, 
postoperative complications, recovery to a regular diet, and the time to first flatus. Secondary 
outcomes will encompass a broader range of indicators, including lymph node harvest, R0 
resection, postoperative mortality, 3-year overall survival, 3-year disease-free survival, operation 
time, blood loss, hospital stay, and reoperation. 
Discussion 
 
To our knowledge, this prospective multicenter observational study will be the first to 
prospectively and objectively assess these two surgical approaches in this context. By evaluating 
short-term perioperative outcomes, complication incidences, and early postoperative recovery, this 
research aims to provide valuable evidence to guide surgical decision-making. The findings may 
contribute to standardizing treatment protocols and improving patient outcomes for this rare subset 
of colorectal cancers. 
Trial Registration: ClinicalTrials.gov ID: [To be completed upon registration] 
Keywords:Splenic flexure cancer, extended colectomy, segmental colectomy, left colectomy, 
extended right colectomy, short-term outcomes, postoperative recovery, colorectal surgery. 

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STEERING COMMITTE 
Name 
Position 
Hospital 
Contact 
Bilgi Baca 
Professor of 
Surgery 
Acibadem 
Altunizade Hospital 
bilgibaca@hotmail.com 
bilgi.baca@acibadem.com 
Cigdem Benlice 
General surgeon 
Ankara University 
Hospital 
cigdembenlice@gmail.com 
X: @cigdembenlice 
Metincan Erkaya 
MD, colorectal 
research fellow 
Acibadem 
Altunizade Hospital 
erkayametincan@gmail.com 
X: @erkayametincan 
Emel Timuçin 
MD, Department 
of Biostatistics 
and Medical 
Informatics 
Acibadem Mehmet 
Ali Aydinlar 
University 
Emel.Timucin@acibadem.edu.tr 
 
 
 
 
 
 
 
 
 
 
 
 

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BACKGROUND INFORMATION & RATIONALE 
Colonic cancers arising at the splenic flexure are relatively rare, accounting only less than 10% 
of all surgically treated colorectal cancers.1,2 These tumors, located at the junction of the left and 
right colonic vasculature, often present challenges in determining the optimal surgical approach 
due to their unique anatomical positioning.3 The surgical options generally considered are left 
colectomy and extended right colectomy.4–6  
The choice between these two surgical approaches can significantly impact various factors, 
including operative time, intraoperative blood loss, lymph node yield, and postoperative 
complications. Moreover, the extent of resection may influence early recovery metrics such as the 
return of bowel function, length of hospital stay, and quality of life in the immediate postoperative 
period.7–9 The splenic flexure's anatomical complexity, characterized by variable blood supply and 
lymphatic drainage, further complicates the decision-making process.3 
While extended right colectomy often allows for a tension-free ileocolic anastomosis and is 
associated with a well-perfused anastomosis, left colectomy may involve high tie of the inferior 
mesenteric artery and ligation of the left branch of the middle colic artery, or selective ligation of 
the left colic artery with a transverse-sigmoid anastomosis. Extended left colectomies sometimes 
necessitate right colonic transposition to achieve a tension-free anastomosis. Despite potential 
benefits, the literature lacks consensus and evidence on which surgical approach provides superior 
short-term outcomes and better early postoperative recovery..8,10 To bridge the existing knowledge 
gap, this study aims to compare the outcomes of left colectomy versus extended right colectomy 
for treating splenic flexure cancers. We will evaluate both short-term perioperative outcomes and 
long-term results to provide evidence-based guidance for optimizing surgical decision-making for 
these challenging tumors. 
 
 
 
 
 

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AUDIT STANDARTS 
Pre-operative 
 
1. Pre-operative Bowel 
Preparation 
Appropriate pre-operative bowel preparation should be 
performed. 
2. Localization of 
Splenic Flexure 
Accurate macroscopic localization of the splenic flexure must 
be corroborated by colonoscopy reports or imaging studies 
(CT scan) or intraoperative exploration. 
3. Antibiotic Use 
Appropriate antibiotic standards should be followed for all 
patients to minimize the risk of postoperative infections and 
promote optimal patient outcomes. 
4. Fluid Balance 
Appropriate fluid balance standards should be established and 
consistently followed for all patients to minimize the risk of 
complications. 
 
Post-operative 
 
1. Critical Care Access 
There must be availability of critical care beds, including both 
level 2 and level 3, along with on-site renal support. 
 
 
 
 
 

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METHODS  
 
1. Summary 
This prospective, multicentric observational cohort study aims to compare 
outcomes between segmental colectomy and extended colectomy for splenic flexure 
cancers based on the surgeon's preference and standard practice at each participating center. 
The study will enroll patients from multiple tertiary centers. Commencing in *****, it will 
span approximately 5 years, including 24 months for patient enrollment and 5 years for 
follow-up, to evaluate both short-term and long-term surgical outcomes. 
 
 
2. Study Aims: 
 
2.1. Primary endpoint:  
To investigate short-term perioperative outcomes, with a focus on postoperative ileus. 
Additional outcomes will include anastomotic leakage, wound infection, and total 
postoperative complications. 
2.2. Secondary endpoint:  
To evaluate long-term and procedural outcomes, such as lymph node harvest, R0 
resection status, postoperative mortality, 3-year overall survival, and 3-year disease-free 
survival. Further, the study will assess operation time, intraoperative blood loss, hospital 
stay duration, and the incidence of reoperation. 
 
 

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3. Project Timeline:  
The study will commence on ***** 1, 2025, with a planned enrollment period of 24 months. 
Each patient will be followed for 36 months to assess both short-term and long-term outcomes. 
Dates 
Description 
1st ***** 2025 
Online launch of SPARROW protocol 
1st ***** 2025 
Virtual conference for SPARROW study launch 
1st  ***** 2025 – 
30st ***** 2025 
Data collection period 1 
(+ 30-day follow-up)  
(+ 6-month follow-up)  
(+ one-year follow-up) 
(+ three-year follow-up) 
(+ five-year follow-up) 
1st ***** 2025 – 
30st ***** 2025 
Data collection period 2 
(+ 30-day follow-up)  
(+ 6-month follow-up)  
(+ one-year follow-up) 
(+ three-year follow-up) 
(+ five-year follow-up) 
1st ***** 2025 – 
30st ***** 2025 
Data collection period 3 
(+ 30-day follow-up)  
(+ 6-month follow-up)  
(+ one-year follow-up) 
(+ three-year follow-up) 
(+ five-year follow-up) 
 
4. Ethics Approval:  
The study protocol will be submitted to the Ethics Committee of Koc University 
for approval. Written informed consent will be obtained from all participants for the 
acquisition and use of anonymised clinical data prior to enrollment, and all investigators 
will conduct this study in accordance with the tenets of the Declaration of Helsinki. 
5. Centre Eligibility:  

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The SPARROW Study is open to any tertiary colorectal cancer centers in Turkey 
and Europe that routinely performs segmental colectomy and extended colectomy for 
splenic flexure cancers.  
o All participating centers must register with the SPARROW study according to local 
regulations. In Turkey, the study must be reviewed and approved by the relevant 
ethics committees, while in Europe, centers should follow their respective national 
guidelines for research approval. 
o Individual study investigators are responsible for obtaining the necessary 
institutional and ethical approvals before initiating data collection. This may 
include registering the study as an audit or service evaluation where applicable. 
o Evidence of successful registration and approval must be submitted to the 
SPARROW study management team prior to the start of data collection. Centers 
will not be permitted to upload patient data onto the study platform without this 
documentation. 
 
Participating surgeons: The participating surgeons should meet the following 
qualifications: 
o Experience with Splenic Flexure Cancers: Surgeons must have completed at least 
20 cases of surgery for colorectal cancer cases per year. 
o Training and Expertise: Surgeons must have completed a general surgery training 
program. 
 
 
 

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6. Patient Eligibility:  
 
a. Inclusion Criteria 
Consecutive adult patients undergoing elective resection of splenic flexure cancer 
will be included in the study. 
 
o Adult patients (≥18 years old) 
o Histologically confirmed adenocarcinoma of the splenic flexure 
o Candidates for curative surgical resection 
o Able to provide informed consent 
 
b. Exclusion Criteria 
o Preoperative imaging examination results showing distant metastasis 
o Previous colorectal or colonic surgery, including history of colectomy 
o Simultaneous or simultaneous multiple primary colorectal cancer 
o Need for an emergency operation because of conditions such as perforation or 
malignant colonic obstruction 
o Significant comorbidities precluding surgery 
o History of any other malignant tumour in the recent 5 years, except for cervical 
carcinoma in situ that has been cured, basal cell carcinoma, or squamous cell 
carcinoma of the skin 
o Colonic stent insertion or primary diverting colostomy before elective surgery 
o History of Ulcerative Colitis or Crohn’s disease 
o Hereditary colon cancer 
o Pregnancy or breastfeeding in women 
o Refusal to provide informed consent 
 
 

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7. Data Governance:  
 
a.   Sample size considerations 
On the basis of previous data comparing extended right colectomy, and left 
colectomy, the incidence of postoperative ileus was observed to be 32.7% (36/110) in the 
extended right colectomy group and 10.9% (12/110) in the left colectomy group. Two-by-
two comparisons yielded a p-value of 0.014 with an odds ratio of 3.97 (95% CI: 1.93–
8.16). Using the categorical variable of postoperative ileus from this retrospective research, 
we calculated our sample size for the prospective study using the Cramer's V method. The 
Cramer's V value was determined to be 0.25. This was assessed using an exact p-value of 
0.05 and a power of 0.80. Based on these parameters, the total sample size needed for the 
study is 126 patients, which would be 63 patients per group. Thus, the total sample size is 
set to 140 patients (70 per group), considering a maximum dropout rate of about 10% for 
this clinical study. 
 
b.   Data Recording 
Data will be collected prospectively and recorded in a standardized case report 
form. Only the principal investigator, co-investigators, and assigned research personnel 
will access to the information. Each hospital has access to their own dataset. The study 
patients’ medical record number will identify patients who are included in the datasheet. 
Included centers must ensure that data collection is at least 90% complete. Centers 
with more than 10% missing data, when considering all data points, will be excluded from 
the final analysis and removed from authorship. There is no minimum patient number 
required per center, provided that all eligible patients treated during the study period are 
included. 
 
c.   Statistical Analysis 
Statistical analysis will be performed using R version 4.2.3. Descriptive statistics 
will summarize patient characteristics. The study will be conducted in two phases: short-
term and long-term outcomes. For the short-term phase, primary outcomes such as 
postoperative complications and immediate surgical outcomes will be compared between 

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left colectomy and extended right colectomy groups using chi-square or Fisher's exact tests 
for categorical variables, and t-tests or Mann-Whitney U tests for continuous variables, as 
appropriate. Multivariable logistic or linear regression models will be used to adjust for 
potential confounders. These short-term results will be published as an interim analysis. 
For the long-term phase, survival outcomes will be analyzed using Kaplan-Meier curves, 
log-rank tests, and Cox proportional hazards models once sufficient follow-up data is 
available.  
Subgroup analyses will explore treatment effects across different patient 
characteristics in both phases. Missing data will be reported and addressed using multiple 
imputation if necessary. Sensitivity analyses will assess the robustness of findings. All tests 
will be two-sided with a significance level of p≤0.05, and adjustments for multiple 
comparisons will be made where appropriate. 
 
8. Variable of Interests:  
 
a.   Demographic, Patient, and Preoperative Variables 
o Age at diagnosis 
o Gender / ASA (American Society of Anesthesiologists) Score 
o Diagnosis date 
o BMI (kg/m²) / Weight loss > 10% / Smoking 
o Previous abdominal surgery  
o Preoperative treatment / Preoperative imaging (US / BT / MRI / Colonoscopy) 
o Tumor size / Tumor position and location 
o Distance to anal verge  
o Bowel preparation 
o Hemoglobin (g/dL) / Albumin (g/dL) / CEA (Carcinoembryonic Antigen) (ng/mL) 
o Clinical TNM (Tumor, Node, Metastasis) Stage 
o Adjuvant therapy / Neoadjuvant therapy 
o Comorbidities: Myocardial Infraction (MI) / Congestive Heart Failure (CHF) / 
Peripheral Vascular Disease (PVD) / Cerebrovascular Accident (CVA) or Transient 
Ischaemic Attack (TIA) / Dementia / Chronic Obstructive Pulmonary Disease 
(COPD) / Connective Tissue Disease (CTD) / Peptic Ulcer Disease (PUD) / 
Hemiplegia / Leukaemia / Lymphoma / Human Immunodeficiency Virus (HIV) or 
Acquired Immunodeficiency Syndrome (AIDS) / Hypertension / Inflammatory 
Bowel Disease (IBD) / Diabetes Mellitus (Type 1 or Type 2) 
o Solid Tumour. If yes: Localised / Metastatic 
o Chronic Kidney Disease (CKD). If yes: Stage I / II / IIIa / IIIb / IV / V 

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b.   Intraoperative Variables 
o Surgical approach (open, laparoscopic, robotic, robotic converted to open, 
laparoscopic converted to open) 
o Total operative time 
o Estimated blood loss (EBL) 
o Anastomosis type 
o Conversion to open surgery 
o Any complications (intraoperative) 
o Type of procedure (Primary anastomosis, Two-step procedure via temporary 
ostomy) 
 
c.   Postoperative Variables 
o Gastrointestinal Symptom Rating Scale 
o First flatus 
o Ileus 
o Quality of life measurements (EORTC QLQ-C30) 
o Return to regular diet / Return to normal activities 
o Postoperative length of stay 
o Readmissions within 30 days 
o 30-day mortality 
o Clavien-Dindo Score 
o Need for a stoma 
o Anastomotic leak 
o Chest infection / Atrial fibrillation / Acute coronary syndrome / Heart failure / Acute 
renal failure 
o Postoperative ileus 
o Clostridium difficile colitis 
o Wound infection 
o Reoperation 
o Follow-up (months) 
o Recurrence 
o Time from the date of surgery to the date of death (Overall Survival - OS) 
o Time from the date of surgery to the date of recurrence or death from any cause 
(Recurrence-Free Survival - RFS) 
 
Tumor Pathology: 
o Histology / Grade 
o Pathological TNM Stage  
o Number of lymph nodes harvested / Number of positive lymph nodes 
o Margins  
o Specimen surface in cm² (range) 
o Tumor size (largest dimension, cm) 
o Microsatellite instability (MSI) / DNA mismatch repair (MMR) 
o Lymphovascular invasion / Perineural invasion 

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9. Authorship:  
Surgeons will bear overall responsibility for data collection. The minimum 
requirements for authorship include: 
 
o Each surgeon must complete a minimum of 10 cases during the data collection 
period to qualify for authorship. 
o Successful completion of data collection at a center that meets the criteria for 
inclusion within the SPARROW dataset is mandatory. 
o The hospital lead surgeon from each center will be responsible for their own data 
collection. 
o The hospital lead surgeon will also maintain communication with the SPARROW 
Steering Committee to ensure compliance with study protocols and timely reporting 
of progress. 
 
Note: If a surgeon provides more than 20 cases during the data collection period, 
they have the right to include two names in the SPARROW study authorship. 
 
 
 

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 APPENDIX A: STUDY DEFINITIONS  
Splenic Flexura:  
The splenic flexure is defined as the colonic segment extending from the distal one-third 
of the transverse colon to the proximal one-third of the descending colon, specifically 10 cm 
from either side, where the distal transverse colon turns toward the proximal descending 
colon. This definition is based on an International Expert Consensus using the Delphi 
Technique. In this study, the distal one-third of the transverse colon to the proximal one-third 
of the descending colon will be accepted as splenic flexure cancers. Accurate macroscopic 
localization of the splenic flexure is essential and must be corroborated by colonoscopy 
reports, imaging studies, or intraoperative exploration. 
 
Surgical technique: 
o Segmental Colectomy: Segmental colectomy (SC) involves the resection of the 
bowel between the left branch of the middle colic artery (MCA) and left colic artery 
(LCA). 
o Extended Colectomy:  
Extended colectomy includes extended right hemicolectomy, left hemicolectomy, 
and subtotal colectomy.  
The definitions of these procedures are as follows: 
Þ Extended right hemicolectomy: Extended right hemicolectomy (ERHC) 
involves resection from the terminal ileum to the middle descending colon, 
ligation of the ileocecal artery (ICA), right colic artery (RCA), MCA and 
LCA. 
Þ Left hemicolectomy: Left hemicolectomy (LHC) involves resection of the 
last third of the transverse colon, descending and sigmoid colon down to the 
recto-sigmoid union, ligation of the left branch of the MCA and inferior 
mesenteric artery (IMA). 

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Þ Subtotal 
colectomy: 
Subtotal colectomy (STC) 
resection of the right, 
transverse, descending and 
sigmoid colon down to the 
rectosigmoid 
union, 
ligation of ICA, RCA, 
MCA and IMA. 
 
Note: The choice of 
laparoscopic or robotic surgical 
approach, as well as the type of 
anastomosis, may be determined based on the surgeon’s experience and preference. 
Definitions of Other Variables: 
o Prolonged postoperative Ileus: Prolonged postoperative ileus was defined by the 
presence of at least two or more of the following symptoms on postoperative day 
4: vomiting/nausea, inability to tolerate oral intake, abdominal distension, or 
radiological findings indicating ileus persisting for more than 24 hours. 
o Anastomotic Leak: An anastomotic leak was defined as the presence of 
extraluminal contrast detected on radiological imaging or as an intraoperative 
finding. Only leaks that necessitated reoperation were included. 
o Postoperative Follow-Up: Patients were scheduled for follow-up appointments 
over a 3-year period. The standard follow-up protocol included clinical 
examinations at 1, 6, 12 and 36 months postoperatively. Patients presenting with 
symptoms indicative of recurrence were investigated immediately. Patients lost to 
follow-up or discharged were tracked through passive follow-up methods. 

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o Reoperation: Reoperation was defined as any surgical intervention performed in 
the operating theatre under regional or general anesthesia following the primary 
surgery, either during the same hospitalization or within 30 days postoperatively. 
o Pathological Assessment: The pathological report included an evaluation of the 
completeness of resection (R-stage), ensuring that at least 12 lymph nodes were 
harvested, and assessing proximal and distal margins. Tumor staging followed the 
8th edition of the American Joint Committee on Cancer (AJCC) classification. 
o Recurrence: Recurrence was defined as the presence of radiological or histological 
evidence indicating the return of the disease. 
o Mortality: Postoperative mortality was defined as death occurring within 30 days 
after surgery. 
 
 
 
 
 
 

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REFERENCES 
1. 
Kim CW, Shin US, Yu CS, Kim JC. Clinicopathologic Characteristics, Surgical Treatment 
and Outcomes for Splenic Flexure Colon Cancer. Cancer Res Treat. 2010;42(2):69. 
doi:10.4143/crt.2010.42.2.69 
 
2. 
Shaikh IA, Suttie SA, Urquhart M, Amin AI, Daniel T, Yalamarthi S. Does the outcome of 
colonic flexure cancers differ from the other colonic sites? Int J Colorectal Dis. 
2012;27(1):89-93. doi:10.1007/s00384-011-1292-7 
 
3. 
Matsuda T, Sumi Y, Yamashita K, et al. Anatomical and embryological perspectives in 
laparoscopic complete mesocoloic excision of splenic flexure cancers. Surg Endosc. 
2018;32(3):1202-1208. doi:10.1007/s00464-017-5792-6 
 
4. 
Cao Y, He M, Chen K, et al. Short- and long-term outcomes after surgical treatment of 
5918 patients with splenic flexure colon cancer by extended right colectomy, segmental 
colectomy and left colectomy: a systematic review and meta-analysis. Front Oncol. 
2024;14. doi:10.3389/fonc.2024.1244693 
 
5. 
de’Angelis N, Hain E, Disabato M, et al. Laparoscopic extended right colectomy versus 
laparoscopic left colectomy for carcinoma of the splenic flexure: a matched case–control 
study. Int J Colorectal Dis. 2016;31(3):623-630. doi:10.1007/s00384-015-2469-2 
 
6. 
Odermatt M, Siddiqi N, Johns R, et al. The short- and long-term outcomes for patients 
with splenic flexure tumours treated by left versus extended right colectomy are 
comparable: a retrospective analysis. Surg Today. 2014;44(11):2045-2051. 
doi:10.1007/s00595-013-0803-2 
 
7. 
Ballal DS, Agrawal HM, Kazi M, Desouza A, Saklani AP. Splenic flexure cancer: is right 
extended hemicolectomy better than left hemicolectomy? Langenbecks Arch Surg. 
2023;408(1). doi:10.1007/s00423-023-03135-5 
 

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8. 
Martín Arévalo J, Moro-Valdezate D, García-Botello SA, et al. Propensity score analysis 
of postoperative and oncological outcomes after surgical treatment for splenic flexure 
colon cancer. Int J Colorectal Dis. 2018;33(9):1201-1213. doi:10.1007/s00384-018-3063-
1 
 
9. 
Ozgur I, Liska D, Valente MA, et al. Best surgical approach for splenic flexure colon 
cancers: Extended versus segmental resection? Am J Surg. 2023;225(3):454-459. 
doi:10.1016/j.amjsurg.2022.11.014 
 
10. 
Gravante G, Elshaer M, Parker R, et al. Extended right hemicolectomy and left 
hemicolectomy for colorectal cancers between the distal transverse and proximal 
descending colon. Ann R Coll Surg Engl. 2016;98(5):303-307. 
doi:10.1308/rcsann.2016.0112 
 
11. 
Benlice C, Parvaiz A, Baca B, et al. Standardization of the Definition and Surgical 
Management of Splenic Flexure Carcinoma by an International Expert Consensus Using 
the Delphi Technique: Room for Improvement? Dis Colon Rectum. 2023;66(6):805-815. 
doi:10.1097/DCR.0000000000002692 
 
12. 
Wang X, Zheng Z, Chen M, Lu X, Huang S, Huang Y, Chi P. Subtotal colectomy, 
extended right hemicolectomy, left hemicolectomy, or splenic flexure colectomy for 
splenic flexure tumors: a network meta-analysis. Int J Colorectal Dis. 2021 Feb;36(2):311-
322. doi: 10.1007/s00384-020-03763-z. Epub 2020 Sep 25. PMID: 32975595. 
 
 
 
 
  
   
 

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