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

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.