Current trends and controversies in the management of patients with splenic flexure tumours

Aim: There exists a variation in practice in the management of tumours around the splenic flexure.We aim to determine the current opinion regarding the management of these tumours.Methods: An anonymised 10-part online questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI).Results: The response rate was 24% (111/464) with approximately half of respondents performing laparoscopic surgery.Electively, an extended right hemicolectomy is the preferred option by 63% of respondents followed by left hemicolectomy (23%) and segmental resection (14%).The upper sigmoid and rectosigmoid is the preferred site of anastomosis by 90% and 10% of respondents respectively.There were no significant differences in the type of operations performed by surgeons who practice laparoscopic or open surgery (p=0.10).A hand-sewn end-to-end anastomosis is most commonly performed (51%) followed by a stapled side-to-side (36%) and a stapled end-to-end (13%) technique.Extended right hemicolectomy is also the preferred option in obstructing tumours.Of surgeons who perform segmental resections, 27% perform an on-table lavage and 9% perform a defunctioning stoma.Internal herniation following laparoscopic resection was only reported by a handful of surgeons.Conclusion: Opinion and practice in the management of patients with tumours around the splenic flexure are divided.Further trials are indicated to determine the best practice.