Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery

The clinicopathological characteristics and outcome of splenic flexure canc er after surgery have yet to be fully elucidated. The aim of the current st udy was, therefore, to establish predictive factors related to splenic flex ure cancer and outcome after surgery. We compared the clinicopathological c haracteristics and outcome of 34 patients with splenic flexure cancers (whi ch represents 3.7% of the total number of colon cancers in our series) with those of 418 patients with right colon and 475 patients with left colon ca ncers by univariate and multivariate analyses, using logistic regression an alysis and Cox's proportional hazards model. Splenic flexure cancers had a high risk of obstruction (26.5% of patients), and had a more advanced stage and lower cure rate than left colon cancers. Logistic regression analysis revealed that two independent factors, colonic obstruction and the presence of distant metastases, were related to the splenic flexure tumor site. Spl enic flexure cancer patients had a poorer outcome than those with left colo n cancer (P = 0.0361). However, there was no difference in survival between patients with splenic flexure, those with right colon cancer and those wit h left colon cancer who underwent curative surgery. Cox's regression analys is revealed that neither the site of splenic flexure nor colonic obstructio n was an independent prognostic factor. In conclusion, splenic flexure canc er is characterized by a high risk of obstruction and the presence of dista nt metastases. However, after curative resection, splenic flexure cancer ha s a similar outcome to colon cancer at other sites. In addition, neither th e splenic flexure site nor colonic obstruction had an independent influence on patient survival after surgery.