![]() There was no difference in overall and progression free survival among the three different surgical treatments. After a median follow-up of 42 months, 30 recurrences and 19 deaths occurred (12 for tumor progression). ![]() In all groups no differences were found in the total number of harvested lymphnodes. No significant differences in complications were found among the three groups. The tumor infiltrated near organs (T4) in 5 patients. Out of 103 selected cases an extended right hemicolectomy was performed in 22 (21.4%) patients, an extended left hemicolectomy in 24 (23.3%) patients, a segmental resection of the splenic flexure in 57 (55.3%) patients the combined resection of adjacent organs showing tumor adherence was carried out in 11 (10.7%) patients. We evaluated the clinicopathological findings and outcomes of all patients and associated them to the different surgical treatment. Between January 2006 and May 2016, 103 patients with splenic flexure colon cancer were enrolled in the study. Extended resection (including distal pancreasectomy and/or splenectomy), has been often indicated for the treatment for the splenic flexure cancer, because the lymphatic drainage at this site is poorly defined and assumed as heterogeneous. Where vascular obstruction develops, when the condition is left untreated or volvulus occurs → rapid progression → severe pain, and even death, can result in hours.Extended right or left hemicolectomy are the most common surgical treatments for splenic flexure colon cancer.Mild cases that consist of little more than partial displacement causing incomplete luminal obstruction may be asymptomatic, or cause low grade pain for days, and may even resolve spontaneously.Depends on degree of displacement, and where the pelvic flexure is located at a given time (as it likely moves and changes position throughout progression of the case).Secondary increases in packed cell volume (PCV Blood: packed cell volume (PCV)) and plasma proteins (TPP Blood: biochemistry - total protein) may be seen, and metabolic acidosis can occur causing tachypnea.Endotoxins and bacteria leak into the bloodstream and peritoneal cavity → damage to epithelial cells and platelets (uncommon with displacement of pelvic flexure).Protein rich fluid leaks into the gut lumen and the peritoneal cavity.Intraluminal distension → progressive ischemia and disruption of the mucosal layers → necrosis and cell sloughing.Progressive arterial obstruction → cyanosis and ischemia → gut spasm → proximal distension of bowel with gas and fluid.Lost circulating blood volume, due to impaired venous drainage → swelling, edema, and congestion → hypovolemia.Progressive vascular occlusion if condition is not treated (if a volvulus develops) →.Mild dehydration while fluid can be reabsorbed in cecum → more severe when complete obstruction forms.Progression of luminal obstructions → mechanical obstruction → secondary gastric distension, which may be relieved with the passage of a nasogastric tube Gastrointestinal: nasogastric intubation.Partial luminal obstruction → distension of more proximal intestines, which results in mild pain.Further changes in gut motility may → worsening of the displacement, and possible complete luminal and vascular obstruction.Displacement of the large colon (either left dorsal, right dorsal, or pelvic flexure displacement) partial colonic luminal obstruction and a partial vascular obstruction → pain due to mesenteric traction, secondary distension of more proximal gut, and ischemia.Rotate on its long axis around the cecum → right displacement of the large colon.Cranially → pelvic flexure displacement.Left dorsal area → nephrosplenic or renosplenic entrapment.Colon is relatively mobile - the left ventral and dorsal colon including the pelvic flexure can move to:.Small strongyle infestation Strongyloides westeri infection.Larger breeds, eg warmbloods Dutch warmblood and heavy horses (colonic displacement) though any breed may be presented.Pelvic flexure retroflexed to lie by the sternum and diaphragm but does not continue to displace to the right of the cecum or to the left into the nephrosplenic space.Accumulation of gas → colon 'floats' to abnormal position.Alternatively, contents of colon may dehydrate and impact secondary to displacement and decreased movement of water into the colon. Pelvic flexure of colon may move secondary to impaction.Unknown, but changes in motility are implicated, ie hypomotility and hypermotility.
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