The following is a summary of “Standardization of the Definition and Surgical Management of Splenic Flexure Carcinoma by an International Expert Consensus Using the Delphi Technique: Room for Improvement?,” published in the June 2023 issue of Diseases of the Colon and Rectum by Benlice et al.
The surgical management of carcinoma located at the splenic flexure continues to be debated within the medical community. This study aimed to establish a consensus among medical experts worldwide regarding managing splenic flexure carcinoma. A 3-round online-based Delphi study was conducted between September 2020 and April 2021 to gather medical insights. The initial round consisted of 18 medical professionals hailing from 12 distinct nations. For the subsequent rounds, every specialist from the initial game was requested to extend invitations to two additional colorectal surgeons (n = 47). Among the 47 invited experts, 42 individuals, accounting for 89% of the participants, actively engaged in the second and third rounds of the consensus process. About 35 inquiries were formulated and dispatched through the online survey platform.
Levels of recommendation based on voting concordance were classified as follows: a consensus of more than 75% was categorized as vital, a harmony between 50% and 75% was categorized as moderate, and an agreement below 50% was categorized as weak. There was average consensus on the medical definition of splenic flexure (55%) as the point located 10 cm from either side where the distal transverse colon transitions into the proximal descending colon. Additionally, medical professionals have advised an abdominopelvic computed tomography (CT) scan and intraoperative exploration (with a moderate consensus of 72%) for tumor localization and inclusion in the cancer registry. Segmental colectomy was the preferred surgical procedure for managing splenic flexure carcinoma in the elective setting, with a preference rate of 72%. A moderate consensus was reached regarding utilizing complete mesocolic excision and central vascular ligation principles for treating splenic flexure carcinoma, with a percentage agreement of 74%.
A robust agreement was reached regarding the surgical methodology for minimally invasive surgery, with a majority of 88%. Subjective decisions are made based on the individual’s expert clinical experience rather than being evidence-based. This is the inaugural globally conducted Delphi consensus study concerning splenic flexure carcinoma. The precise characterization of splenic flexure remains unclear in medical literature. To enhance the comparability of oncologic outcomes across various cancer registries, it is imperative to establish medical guidelines that standardize each domain and prevent subjective definitions.
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