Short- and Long-Term Outcomes of Laparoscopic Segmental Left Colectomy for Splenic Flexure Colon Cancer: A Multicenter Propensity Score-Matched Analysis from the Catholic Colorectal Group

Background: Splenic flexure colon cancer (SFCC) is a relatively rare subtype of colon cancer, and the optimal extent of resection and safety of laparoscopic surgery remain controversial. We conducted a multicenter comparative analysis to evaluate the short- and long-term outcomes of laparoscopic segmental left colectomy (LC) for SFCC using laparoscopic anterior resection (AR) as a comparator. Methods: We retrospectively reviewed patients with stage I–III colon cancer involving the distal transverse to sigmoid colon who underwent laparoscopic surgery at four hospitals between March 2004 and December 2020. SFCC was defined as tumors between the distal transverse and proximal descending colon. Outcomes were compared between the AR group (laparoscopic anterior resection for descending to sigmoid colon cancer) and the LC group (laparoscopic segmental left colectomy for SFCC) using propensity score matching. Results: A total of 1889 patients were included in the AR group and 271 in the LC group. The median follow-up was 60 months. After 2:1 propensity score matching, baseline clinicopathologic characteristics were comparable between groups. Operative time was longer in the LC group. Overall complication rates were similar, except for a higher incidence of postoperative ileus in the LC group, while overall 30-day morbidity did not differ. Five-year disease-free survival and overall survival were comparable, with no significant differences in stage-stratified analyses. Conclusions: Laparoscopic segmental left colectomy for SFCC achieved short- and long-term outcomes comparable to laparoscopic anterior resection for descending and sigmoid colon cancer, supporting it as a safe and oncologically feasible option.