A scoping literature review on the surgical management of splenic flexure tumors

Abstract

Background:

Splenic flexure cancer is relatively uncommon, accounting for less than 5% of all colorectal cancers with challenging surgical treatment because of their unique anatomic location, blood supply, and lymphatic drainage. The aim of this review was to evaluate the current landscape of surgical management of splenic flexure tumors splenic flexure tumors, assessing available evidence and highlighting areas for future research.

Methods:

Scoping review of literature up to March 2025, reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results:

Current evidence on the surgical management of splenic flexure tumors relies on analysis of retrospective studies, which are limited by heterogeneity in definitions and significant selection bias. Based on the available evidence, both extended and limited resections appear to result in similar short- and long-term outcomes as well as pathologic outcomes in elective, non-obstructive settings. The certainty of evidence for these outcomes, though, is very low, precluding any safe recommendations for any procedure. Regarding the extent of lymph node dissection, there is no conclusive evidence favoring D3 or central vascular ligation over D2 lymphadenectomy. Minimally invasive surgery is considered safe in experienced hands. Personalized preoperative planning is important due to the highly variable vascular anatomy at the splenic flexure.

Conclusion:

Surgical treatment of splenic flexure tumors remains controversial due to the lack of high-quality prospective data. No single approach can currently be recommended for all cases. Until randomized trials provide definitive guidance, individualized surgical strategies that respect embryologic planes, ensure oncological adequacy, and account for anatomic variability should be pursued. Future directions should focus on standardizing definitions, improving pathologic evaluation of mesocolic integrity, and designing randomized trial to avoid selection bias.

Keywords

Splenic flexure tumors surgery scoping review

Introduction

Splenic flexure cancer is relatively uncommon, accounting for less than 5% of all colorectal cancers.¹ Challenges in the surgical treatment of splenic flexure tumors (SFTs) emanate from their unique anatomic location, blood supply, and lymphatic drainage. Currently, the surgical management of SFT entails several controversies due to a lack of standardized definitions, high-quality evidence, and dedicated guidelines. These controversies include the extent of colon resection, the extent of lymphadenectomy, and approaches to ligation of the feeding vessel(s). This review aimed to evaluate the current landscape of surgical management of SFTs, assessing available evidence and highlighting areas for future research.

Methods

This scoping review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for scoping reviews.² The protocol was registered a priori in PROSPERO under the special identifier (CRD420251045788). MedLine was searched through PubMed from the database inception by two different authors (ZG and MP) through March 2025 along with Google Scholar. The keywords such as “splenic flexure,” “left colic flexure,” “cancer,” “adenocarcinoma,” “tumor,” “surgery,” “surgical management,” “treatment,” “resection,” “colectomy,” “complete mesocolic excision,” “CME,” “D3 dissection,” “lymphadenectomy,” “lymphatic mapping,” “ICG,” “laparoscopy,” “open colectomy,” and “minimally invasive” were used in combination with the Boolean operators AND/OR to identify all available studies on surgical management of SFTs. The full-search strategy is available in Supplementary Material 1. The reference lists of the included studies were also screened for any further eligible studies. All English studies involving humans (either cadaveric models or alive patients) on the surgical management of SFTs were retrieved and synthesized narratively to describe the current surgical landscape for SFTs. Studies deemed eligible for inclusion were systematic reviews, meta-analyses, randomized controlled trials (RCTs), propensity score–matched studies, cohort studies, and published clinical guidelines. The highest level of available evidence on each research question was first considered. ChatGPT³ was used for the technical construction of the table with content provided by the authors. ROBIS⁴ and GRADE⁵ were used to assess the bias of the included studies and the certainty of evidence on the outcomes, respectively. The review entailed only qualitative analyses of evidence, with no attempt to quantitatively pool the data because of the expected heterogeneity.

Results

Definition of SFTs

The definition of SFT is controversial. While tumors located at the junction between the transverse and the descending colon are clearly SFTs, the proximity of the tumor to either the transverse or the descending colon is not established. Unfortunately, there is no good evidence or cadaveric studies to answer this question. Nevertheless, a group of experts⁶—the Splenic Flexure Cancer Delphi Consensus Study Group—tried to reach an agreement regarding the SFTs. The experts recommended defining an SFT as any tumor located “10 cm on either side where the distal transverse colon turns into the proximal descending colon.” Nonetheless, this definition had a moderate consensus of 55% after three rounds of voting, and thus, the definition remains quite controversial.

Surgical procedure for SFTs

There is a plethora of systematic reviews and meta-analyses of retrospective studies on the ideal surgical approach to SFTs; however, each is associated with a significant selection bias. The main question is whether an extended or a segmental resection is sufficient for treating SFTs. Again, terminology issues arise, as some authors use “extended resection” to mean extended right colectomy, and others imply subtotal colectomy, without defining the extent of bowel resection or vascular ligation. While extended right and subtotal colectomy are not the same procedure, several manuscripts collectively assessed those procedures together.

To ascertain the best surgical approach to SFTs, results are assessed relative to short-term surgical outcomes and safety, pathologic outcomes, and long-term oncological outcomes.

Short-term surgical outcomes

Several systematic reviews and meta-analyses assessed the short-term outcomes of segmental and extended resections of SFTs.^7–13 Hajibandeh et al.⁷ and Martinez-Pérez et al.⁸ reported equivalent short-term postoperative outcomes of extended right colectomy, segmental colectomy, and left hemicolectomy. More specifically, a meta-analysis of 956 patients showed no significant differences in complications such as anastomotic leakage, severe complications, mortality, reoperation, or hospital stay among the three procedures.⁷ However, extended right colectomy was associated with higher odds of ileus (odds ratio (OR) = 2.74, p = 0.002), whereas segmental colectomy had a shorter operative time by an average of 25.5 min.

These results were confirmed by a recent network meta-analysis of 13 retrospective studies,¹⁰ involving 6176 patients which demonstrated no significant differences among three procedures in postoperative outcomes, except for shorter operative time by about 30 min in favor of segmental colectomy and higher likelihood of ileus after extended right colectomy (OR = 3.47, 95% confidence interval (CI) = 1.11–10.84), despite the much larger study population compared to the previous studies.

Four propensity score–matched studies^14–17 confirmed the above results. Interestingly, 23% of patients in one study¹⁴ required additional colorectal maneuvers such as retroileal transposition or Deloyers procedure to achieve a tension-free anastomosis after left hemicolectomy, which may render a much more technically demanding reconstruction than a standard colorectal anastomosis. The short-term outcomes from six recent meta-analyses are summarized in Table 1.

Table 1.

Short-term surgical outcomes.

Outcome	Hajibandeh et al.⁷	Martínez-Pérez et al.⁸	Wang et al.⁹	Lennon et al.¹⁰	Cheng et al.¹¹	Morarasu et al.¹²	Chaouch et al.¹³
No. of Studies	10	8	10	13	7	6	12
No. of Patients	956	594	1157	6176	867	1004	1710 (713 ERC; 997 LC)
Anastomotic Leak (%)	OR 1.07 (95% CI 0.61–1.87, p = 0.82, I² = 0%)	No significant difference (p = 0.73)	OR 0.95 (95% CI 0.62–1.46, p = 0.82, I² = 0%)	OR 1.11 (95% CI 0.78–1.59, p = 0.57, I² = 18%)	OR 1.01 (95% CI 0.62–1.64, p = 0.98)	No significant difference	OR 1.29 (0.81–2.05, p = 0.28)
Reoperation Rate (%)	OR 0.97 (95% CI 0.53–1.79, p = 0.92, I² = 0%)	No significant difference	Not reported	OR 1.02 (95% CI 0.74–1.41, p = 0.91, I² = 0%)	Not reported	Not reported	OR 1.71 (0.83–3.52, p = 0.15)
Ileus (%)	OR 2.74 (95% CI 1.46–5.14, p = 0.002, I² = 0%) (higher in ERC)	Not reported	OR 1.69 (95% CI 1.11–2.59, p = 0.015, I² = 0%) (higher in ERC)	OR 3.47 (95% CI 1.11–10.84, p = 0.03, I² = 0%)	OR 2.16 (95% CI 1.14–4.09, p = 0.02)	Not reported	OR 2.04 (0.71–5.83, p = 0.18)
Operative Time (minutes)	MD -25.48 min (95% CI -36.99 to -13.96, p < 0.0001, I² = 64%) (shorter in SC)	Shorter in SC, MD -27 min (p < 0.001)	MD -24.7 min (95% CI -36.0 to -13.4, p < 0.0001)	MD -29.8 min (95% CI -43.7 to -15.9, p < 0.0001, I² = 81%)	MD -26.5 min (95% CI -38.7 to -14.3, p < 0.001)	Shorter operative time in SC (NS)	MD 0.18 (CI -0.15 to 0.51, p = 0.29) (SMD)
Overall Complications (%)	OR 1.06 (95% CI 0.73–1.53, p = 0.76, I² = 0%)	No significant difference (p = 0.55)	OR 0.96 (95% CI 0.71–1.29, p = 0.78)	OR 0.91 (95% CI 0.73–1.14, p = 0.41, I² = 10%)	OR 0.97 (95% CI 0.72–1.31, p = 0.85)	No significant difference	OR 0.93 (0.63–1.38, p = 0.72)

Short-term postoperative outcomes from six meta-analyses comparing segmental colectomy (SC), extended right colectomy (ERC), left hemicolectomy (LHC), and subtotal colectomy (STC) for splenic flexure tumors. Pooled estimates are presented as odds ratios (OR), mean differences (MD), or weighted mean differences (WMD) with corresponding 95% confidence intervals (CIs), p-values, and heterogeneity statistics (I²). Where data were unavailable, outcomes are described narratively.

The evidence on short-term outcomes was graded as very low (Supplementary Material 3) because all studies had significant selection bias: obstructive tumors are more likely to undergo extended resections, increasing the risk of ileus because of preoperative bowel dilatation rather than the resection per se. Furthermore, the studies inconsistently defined ileus based on varying postoperative day thresholds. Given the lack of RCTs and based on the current evidence, it is not feasible to advocate one procedure over the others based on superior short-term outcomes.

Pathologic outcomes

The same meta-analyses^7–13 and propensity score–matched studies^14–17 demonstrated that pathologic outcomes were not significantly different between segmental colectomy, extended right colectomy, and left hemicolectomy, as R0 resection rates, achieving ⩾12 lymph node yields, and negative resection margins were similar. The only significant reported difference was a higher lymph node yield in the extended right colectomy group. All results on the pathologic outcomes are summarized in Table 2. Again, the certainty of evidence for pathologic outcomes was very low (Supplementary Material 3), precluding any strong recommendations of one technique over another.

Table 2.

Pathologic outcomes.

Outcome	Hajibandeh et al.⁷	Martínez-Pérez et al.⁸	Wang et al.⁹	Lennon et al.¹⁰	Cheng et al.¹¹	Morarasu et al.¹²	Chaouch et al.¹³
No. of Studies	10	8	10	13	7	6	12
No. of Patients	956	594	1157	6176	867	1004	1710 (713 ERC; 997 LC)
R0 Resection Rate (%)	OR 0.97 (95% CI 0.45–2.06, p = 0.94, I² = 0%)	No difference reported (NS)	No difference (NS)	OR 1.08 (95% CI 0.61–1.93, p = 0.79, I² = 0%)	No significant difference	No significant difference	OR 2.16 (95% CI 0.89-5.29, p = 0.09)
Lymph Node Yield (Mean ± SD or MD)	MD + 2.8 nodes in ERC versus SC (95% CI + 1.3 to + 4.2, p = 0.0003, I² = 0%)	Slightly higher in ERC (NS)	MD + 3.62 nodes (95% CI + 2.10 to + 5.14, p < 0.001, I² = 25%)	WMD + 3.21 nodes (95% CI + 1.16 to + 5.26, p = 0.002, I² = 38%)	MD + 2.55 nodes (95% CI + 1.11 to + 3.99, p = 0.0006)	Slightly higher in ERC (NS)	WMD 0.83 (95% CI 0.35-1.31, p < 0.001)
Margin Status (Negative Margins)	No significant difference (p = 0.85)	No significant difference	No difference reported	OR 0.93 (95% CI 0.52–1.65, p = 0.80)	No significant difference	No significant difference

Pathologic outcomes from six meta-analyses assessing surgical treatment of splenic flexure tumors. Lymph node yield is reported as the mean or weighted mean difference (MD/WMD) between procedures. Data are presented with 95% confidence intervals (CIs), p-values, and heterogeneity (I²) where available.

Long-term outcomes

The three surgical approaches to SFTs were associated with similar overall and disease-free survival, based on systematic reviews and propensity score studies.^7–17 The detailed results are shown in Table 3. As expected, the certainty of evidence for long-term outcomes was also deemed very low (Supplementary Material 3).

Table 3.

Long-term oncologic outcomes.

Outcome	Hajibandeh et al.⁷	Martínez-Pérez et al.⁸	Wang et al.⁹	Lennon et al.¹⁰	Cheng et al.¹¹	Morarasu et al.¹²	Chaouch et al.¹³
No. of Studies	10	8	10	13	7	6	12
No. of Patients	956	594	1157	6176	867	1004	1710 (713 ERC; 997 LC)
Overall Survival (OS)	No difference (pooled HR not reported; NS narrative)	HR not pooled; NS	HR not reported	HR 1.09 (95% CI 0.80–1.49, p = 0.59, I² = 12%)	HR 1.04 (95% CI 0.76–1.42, p = 0.79)	No significant difference	HR not reported
Disease-Free Survival (DFS)	Not reported	Not analyzed separately	Not reported	HR 0.95 (95% CI 0.74–1.22, p = 0.68, I² = 9%)	HR 1.01 (95% CI 0.72–1.42, p = 0.93)	No significant difference	HR not reported
Cancer-Specific Survival (CSS)	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	HR not reported
5-Year OS (%)	Not consistently pooled	Not consistently reported	STC: 71.4%, SC: 69.7%, ERC: 70.5% (NS)	Not reported	Not pooled	SC: 70.2%, ERC: 72.3%, NS	OR 0.88 (95% CI 0.68-1.13, p = 0.31)
5-Year DFS (%)	Not consistently pooled	Not reported	SC: 67.3%, STC: 68.9%, NS	Not pooled	Not pooled	Not pooled	OR 0.79 (95% CI 0.62-1.00, p = 0.05)

Long-term oncologic outcomes following surgical resection of splenic flexure tumors, based on six systematic reviews and meta-analyses. Outcomes include overall survival (OS), disease-free survival (DFS) and, where reported, cancer-specific survival (CSS). Pooled hazard ratios (HRs) with 95% confidence intervals (CIs), p-values, and heterogeneity (I²) are provided. Five-year OS and DFS rates are included when formal HRs were not reported.

Emergency setting

In cases of SFT causing bowel obstruction, the disparity between the diameters of the proximal and distal colonic lumens restricts surgical options, particularly regarding the safety of a primary anastomosis. In this setting, an extended right colectomy or subtotal colectomy with ileorectal anastomosis is usually preferred to avoid the need for a stoma.⁶

Quality of life

Another thing to consider is quality of life associated with each procedure. Patients with poor sphincter function or pelvic floor issues may be impacted from an extended right colectomy or an ileorectal anastomosis. In an elective setting, these details have to be discussed with patient, and an informed decision should be made based on pros/cons of each operation, always respecting the patient’s wishes.

Current guidelines on SFTs

The European Society for Medical Oncology (ESMO) guidelines do not have specific recommendations for SFTs. In general terms, for colon cancer, they recommend a resection that includes at least 5 cm margins on either side of the tumor, along with en bloc mesenteric resection and ensuring that at least 12 lymph nodes are harvested.¹⁸ The National Comprehensive Cancer Network (NCCN) guidelines for colon cancer¹⁹ similarly recommend adequate lymphadenectomy with proximal ligation of the associated vascular pedicle(s), ensuring at least 12 lymph nodes are retrieved. The Japanese Guidelines²⁰ are more precise, recommending D3 lymphadenectomy for every cT2 or higher tumor and/or N(+) disease, based on detailed characterization of colonic lymph node stations. They define the extent of resection based on tumor location relative to the feeding vessels, usually ranging from 5 cm to 10 cm, depending on anatomical variability.

Ligation of vessels—lymphatic mapping

The splenic flexure lies at the junction between the midgut (supplied by the superior mesenteric artery via the middle colic artery) and the hindgut (supplied by the inferior mesenteric artery via the left colic artery). This anatomic position allows for a dual lymphatic drainage, with metastatic pathways possibly extending from paracolic nodes to the superior mesenteric artery (SMA), middle colic artery, accessory middle colic artery, inferior mesenteric artery (IMA), or left colic artery. A study by Vasey et al.²¹ demonstrated that lymphatic drainage from the normal splenic flexure is predominantly directed toward the left colic pedicle (96%), with the middle colic pedicle being the second most common. Similarly, Watanabe et al²² used intraoperative real-time indocyanine green (ICG) lymphography in 31 patients and found that the lymphatic flow was directed toward the root of the inferior mesenteric vein (IMV) in 61.3% of patients, with drainage exclusively toward either the left colic or the left branch of the middle colic artery, but never both. The same group showed that intraoperative ICG lymphography altered the surgical plan in 5 out of 19 patients undergoing surgery for SFTs, emphasizing the unpredictability of lymphatic drainage.

Adding to the complexity, a recent meta-analysis by Murono et al.²³ showed that the branches of the middle colic artery can independently arise independently in 8.9%–33.3% of cases. The left colic artery was absent in up to 7.5%, and an accessory middle colic artery was present in 6.7%–48.9% of cases. This heterogeneity in vascular anatomy significantly contributes to the difficulty in standardizing the surgical approach for SFTs. Preoperative vascular mapping may serve as a valuable tool to guide safe and radical resections of SFTs.

Extent of lymphadenectomy

Several studies, especially systematic reviews and meta-analyses, have been published on the extent of lymphadenectomy in SFTs.^24–33 Most of these meta-analyses aggregate results of studies using interchangeably the terms central vascular ligation (CVL), D3 lymphadenectomy, and complete mesocolic excision (CME).

CVL refers to a high vascular tie at the origin of the feeding vessel and implies oncologic radicality at the vessel origin. D3 dissection refers to lymph node clearance at central (D3) lymph node stations as have been defined by the Japanese Guidelines.²⁰ Conversely, CME refers to tissue planes and specimen quality: it involves sharp dissection along embryological planes to preserve the mesocolic envelope. Therefore, D3 dissection can be performed without CVL, while CVL does not ensure complete D3 clearance. On the contrary, CME focuses on the mesocolic envelope, not necessarily on vascular or nodal radicality (Table 4). The results are not fully convincing, despite a marginal survival benefit in stage III colon cancer,^25–33 and no recommendations can be currently made regarding the extent of lymphadenectomy.

Table 4.

Conceptual and anatomical distinctions between central vascular ligation (CVL), complete mesocolic excision (CME), and D3 lymphadenectomy in colon cancer surgery.

Term	Definition	Purpose/Surgical Focus
CVL	High vascular tie at the origin of feeding arteries and veins (e.g. SMA, IMA)	Oncologic radicality at vessel origin
CME	Sharp dissection along embryological planes to preserve the mesocolic envelope	Tissue planes and specimen quality
D3 Dissection	Removal of lymph nodes along the main vascular trunks up to the root of the mesentery	Lymph node clearance at central stations

Conceptual and anatomical distinctions between central vascular ligation (CVL), complete mesocolic excision (CME), and D3 lymphadenectomy in colon cancer surgery. CVL emphasizes high vascular tie at the origin of major feeding vessels (e.g. superior and inferior mesenteric arteries), aiming for oncologic radicality at the root. CME refers to sharp dissection along embryological planes to preserve mesocolic integrity and optimize specimen quality. D3 dissection, primarily derived from Japanese surgical anatomy, focuses on clearance of lymph node stations at the central mesenteric axis. While these terms are sometimes used interchangeably in the literature, they represent anatomically and technically distinct goals.

Two ongoing studies, a randomized trial on D2 versus D3 lymphadenectomy for colon cancer³⁴ and a prospective observational cohort on the extent of resection and central radicality³⁵ may help resolve this query in the next few years.

Mesocolic excision—operating along embryologic planes

Akin to total mesorectal excision (TME) in rectal cancer, every colonic excision should respect the embryologic planes, and the specimen should be assessed to ensure the quality and adequacy of the surgery performed. The mesocolic integrity should be reported in the pathology report similar to TME grading.³⁶ Operating while respecting the embryological planes in colectomy has proven its superiority since 2008, when West et al.³⁶ demonstrated three possible planes during a colectomy: muscularis propria plane, intramesocolic, and mesocolic. The authors demonstrated a 15% overall 5-year survival advantage in the mesocolic versus the muscularis propria group (hazard ratio (HR) = 0.57, 95% CI = 0.38–0.85). Again, the mesocolic excision and the respect of the embryological plane should not be confused with the extent of lymphadenectomy and the level of vascular ligation.

Minimally invasive versus open surgery

While there are quite a few RCTs comparing laparoscopic to open surgery for colon cancer, the majority of them excluded SFTs.^37–45 Only two RCTs^38,43 included SFTs, and their results demonstrated non-inferiority of the laparoscopic approach compared to open surgery in terms of oncologic outcomes (Table 5). There are few meta-analyses and retrospective studies^46–49 on SFTs that arrived at similar conclusions, but with a lower level of evidence that is not strong enough upon which to create evidence-based recommendations. Therefore, minimally invasive surgery (MIS) in expert hands may be safe and oncologically noninferior to open surgery for SFTs.

Table 5.

Summary of key randomized trials comparing laparoscopic versus open resection for colon cancer.

Trial name	Year	Country/Region	Key findings	Included splenic flexure tumors?
COST Trial (Clinical Outcomes of Surgical Therapy)³⁷	2004	USA	No significant difference in 3-year DFS.Laparoscopic group faster recovery.	Yes (partially)
COLOR Trial (COlon cancer Laparoscopic or Open Resection)³⁸	2005	Europe	Comparable 3-year survival.Laparoscopy quicker recovery, less blood loss	No
CLASICC Trial (Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer)³⁹	2005	UK	Laparoscopy safe oncologicallyShort-term benefits, higher conversion rate	Unclear
Barcelona Trial⁴⁰	2002	Spain	Lower complications and shorter stay with laparoscopy; equivalent oncologic outcomes.	Unclear (likely some)
JCOG0404 Trial (Japan Clinical Oncology Group)⁴¹	2012	Japan	No difference in 5-year survival.Laparoscopic group less blood loss and faster recovery	No
ALCCaS Trial (Australasian Laparoscopic Colon Cancer Study)⁴²	2008	Australia/New Zealand	Similar oncologic outcomes; laparoscopy had better short-term recovery.	Yes
Enroll Trial (Enhanced Recovery Open versus Laparoscopic)⁴³	2012	UK	Laparoscopy improved QoL and return to activity in ERAS setting	Unclear
LAFA Trial⁴⁴	2010	The Netherlands	Laparoscopy + ERAS yielded the best short-term outcomes	Unclear

While most trials demonstrated equivalence in survival outcomes and improved recovery with laparoscopy, the inclusion of splenic flexure tumors was inconsistent or poorly defined, highlighting a gap in subgroup-specific evidence for this anatomical location.

Summary of evidence—future directions

Surgery for SFT, as for any other part of the colon, should respect the mesocolic planes and ensure adequate margins as defined by the guidelines. Both extended and limited resection may confer similar short-term and long-term outcomes in elective non-obstructive cases, but given the lack of solid evidence, the superiority of one approach over the other cannot be verified. MIS seems to be safe in experienced hands. The feeding vessel(s) should be ligated, ensuring that at least 12 lymph nodes are retrieved. There is no good evidence to support D3 or CVL over D2 dissection for SFTs.

Given the very variable vascular anatomy of the area, surgical procedures should be individualized with very good preoperative planning (fluorescence-guided surgery or preoperative vascular imaging). The perfusion of the two ends of the bowel should be meticulously evaluated before anastomosis, given the vascular anatomy variability.

It is clear now what we need to further advance our practice:

RCTs comparing the procedures.

Clear definitions in terms of SFT, procedure, and extent of lymphadenectomy.

Promote and popularize the thorough pathologic assessment of the specimen, with photographic evidence of the procedure described, to advance patient outcomes along with surgical practice.

Limitations

The available evidence is based on systematic reviews and meta-analyses of retrospective studies with significant selection bias. This review does not recommend a surgical approach but rather highlights the gaps in available literature and future research directions for the global scientific community.

Conclusion

SFTs are a unique entity with much controversy. The evidence is not strong enough to adamantly recommend any procedure for elective cases; therefore, individualized approaches, with careful preoperative planning, respect for embryologic planes, adequate margins, ligation of the feeding vessels, and a 12-lymph-node yield, are recommended. Randomized trials are needed to delineate the optimal surgical plan.

Supplemental Material

sj-docx-1-sjs-10.1177_14574969251387491 – Supplemental material for A scoping literature review on the surgical management of splenic flexure tumors

Supplemental material, sj-docx-1-sjs-10.1177_14574969251387491 for A scoping literature review on the surgical management of splenic flexure tumors by Zoe Garoufalia, Sameh H. Emile, Nir Horesh, Michal Perets, Noam Kahana and Steven D. Wexner in Scandinavian Journal of Surgery

Supplemental Material

sj-docx-2-sjs-10.1177_14574969251387491 – Supplemental material for A scoping literature review on the surgical management of splenic flexure tumors

Supplemental material, sj-docx-2-sjs-10.1177_14574969251387491 for A scoping literature review on the surgical management of splenic flexure tumors by Zoe Garoufalia, Sameh H. Emile, Nir Horesh, Michal Perets, Noam Kahana and Steven D. Wexner in Scandinavian Journal of Surgery

Supplemental Material

sj-docx-3-sjs-10.1177_14574969251387491 – Supplemental material for A scoping literature review on the surgical management of splenic flexure tumors

Supplemental material, sj-docx-3-sjs-10.1177_14574969251387491 for A scoping literature review on the surgical management of splenic flexure tumors by Zoe Garoufalia, Sameh H. Emile, Nir Horesh, Michal Perets, Noam Kahana and Steven D. Wexner in Scandinavian Journal of Surgery

Footnotes

Author contributions

Zoe Garoufalia: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Validation; Visualization; Writing—original draft.

Sameh Hany Emile: Data curation; Formal analysis; Writing—original draft; Writing—review and editing.

Nir Horesh: Data curation; Formal analysis; Writing—original draft; Writing—review and editing.

Michal Perets: Data curation; Formal analysis; Writing—original draft; Writing—review and editing.

Noam Kahana: Data curation; Formal analysis; Writing—original draft; Writing—review and editing.

Steven D. Wexner: Conceptualization; Project administration; Supervision; Writing—review and editing.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr S.D.W. is a consultant for Activ Surgical, Arthex, Baxter, Becton, Dickinson and Co., Intuitive Surgical, OstomyCure, Takeda, and Virtual Ports; has consulting agreements with stock options for consulting with GI View, OstomyCure, and Virtual Ports; is the Data Safety Monitoring Board chair of Polypid; and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC. Dr S.H.E. is a consultant for Becton, Dickinson and Co. None of the remaining authors reports any financial disclosures.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Sameh H. Emile

Steven D. Wexner

Supplemental material

Supplemental material for this article is available online.

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