Abstract：
OBJECTIVE: The optimum surgical approach to splenic flexure cancers (SFCs) remains uncertain. The aim of this survey was to explore the opinions of an international surgical community on the management and outcomes of SFC.
METHODS: A questionnaire was constructed comprising five sections (information about respondents; definition and prognosis of SFC; operative approach; approach in specific scenarios; outcomes) and circulated through an international dissemination committee and social media.
RESULTS: The survey received 576 responses over 4 weeks across 50 countries. There was no consensus regarding the definition of the splenic flexure, whilst the proportion of respondents who did and did not think that patients with SFC had a worse outcome was equal. The overall preferred operative approach was left hemicolectomy [203 (35.2%)], followed by segmental resection [167 (29%)], extended right hemicolectomy [126 (21.9%)] and subtotal colectomy [7 (12%)]. The stated pedicles for ligation varied between resection types and also within the same resection. One hundred and sixty-six (28.8%) respondents thought a segmental resection was associated with the worst survival and 190 (33%) thought it was associated with the best quality of life.
CONCLUSIONS: This survey confirms a lack of consensus across all aspects SFC treatment. The differing approaches described are likely to represent different beliefs around the variable anatomy of this region and the associated lymphatic drainage. Future studies are required to address such inconsistencies and identify the optimum surgical strategy, whilst also incorporating quality-of-life metrics and patient-reported outcomes. A one-size-fits-all approach is probably not appropriate with SFC, and a more bespoke approach is required.
METHODS: A questionnaire was constructed comprising five sections (information about respondents; definition and prognosis of SFC; operative approach; approach in specific scenarios; outcomes) and circulated through an international dissemination committee and social media.
RESULTS: The survey received 576 responses over 4 weeks across 50 countries. There was no consensus regarding the definition of the splenic flexure, whilst the proportion of respondents who did and did not think that patients with SFC had a worse outcome was equal. The overall preferred operative approach was left hemicolectomy [203 (35.2%)], followed by segmental resection [167 (29%)], extended right hemicolectomy [126 (21.9%)] and subtotal colectomy [7 (12%)]. The stated pedicles for ligation varied between resection types and also within the same resection. One hundred and sixty-six (28.8%) respondents thought a segmental resection was associated with the worst survival and 190 (33%) thought it was associated with the best quality of life.
CONCLUSIONS: This survey confirms a lack of consensus across all aspects SFC treatment. The differing approaches described are likely to represent different beliefs around the variable anatomy of this region and the associated lymphatic drainage. Future studies are required to address such inconsistencies and identify the optimum surgical strategy, whilst also incorporating quality-of-life metrics and patient-reported outcomes. A one-size-fits-all approach is probably not appropriate with SFC, and a more bespoke approach is required.
摘要：
目的：脾曲癌（SFCs）的最佳手术方式仍不确定。这项调查的目的是探讨国际外科界对SFC的管理和结果的看法。
方法：问卷由五个部分组成（有关受访者的信息；SFC的定义和预后；手术方法；特定情况下的方法；结果），并通过国际传播委员会和社交媒体分发。
结果：该调查在4周内收到了50个国家的576份回复。关于脾曲的定义没有达成共识，而接受和不认为SFC患者结局较差的受访者比例相等.整体首选手术入路为左半结肠切除术[203（35.2%）]，其次是节段性切除[167（29%）]，扩大右半结肠切除术[126(21.9%)]和结肠次全切除术[7(12%)].用于结扎的所述椎弓根在切除类型之间以及在同一切除范围内有所不同。一百六十六（28.8％）的受访者认为节段性切除术与最差的生存率有关，190（33％）的受访者认为与最佳的生活质量有关。
结论：这项调查证实了在所有方面SFC治疗缺乏共识。所描述的不同方法可能代表围绕该区域的可变解剖结构和相关的淋巴引流的不同信念。未来的研究需要解决这种不一致，并确定最佳的手术策略。同时还纳入了生活质量指标和患者报告的结局。一刀切的方法可能不适合证监会，并且需要更定制的方法。
方法：问卷由五个部分组成（有关受访者的信息；SFC的定义和预后；手术方法；特定情况下的方法；结果），并通过国际传播委员会和社交媒体分发。
结果：该调查在4周内收到了50个国家的576份回复。关于脾曲的定义没有达成共识，而接受和不认为SFC患者结局较差的受访者比例相等.整体首选手术入路为左半结肠切除术[203（35.2%）]，其次是节段性切除[167（29%）]，扩大右半结肠切除术[126(21.9%)]和结肠次全切除术[7(12%)].用于结扎的所述椎弓根在切除类型之间以及在同一切除范围内有所不同。一百六十六（28.8％）的受访者认为节段性切除术与最差的生存率有关，190（33％）的受访者认为与最佳的生活质量有关。
结论：这项调查证实了在所有方面SFC治疗缺乏共识。所描述的不同方法可能代表围绕该区域的可变解剖结构和相关的淋巴引流的不同信念。未来的研究需要解决这种不一致，并确定最佳的手术策略。同时还纳入了生活质量指标和患者报告的结局。一刀切的方法可能不适合证监会，并且需要更定制的方法。
