Cheok SHX, Jabbar SAA, Wong NW, Ngu JCY, Teo NZ. Surgical management of splenic flexure colonic malignancy. World J Gastrointest Surg 2025; 17(12): 111582 [DOI: 10.4240/wjgs.v17.i12.111582]
Corresponding Author of This Article
Nan-Zun Teo, Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. teo.nan.zun@singhealth.com.sg
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2025; 17(12): 111582 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.111582
Surgical management of splenic flexure colonic malignancy
Sabrina Hui-Xian Cheok, Salman Ahmed Abdul Jabbar, Neng-Wei Wong, James Chi-Yong Ngu, Nan-Zun Teo
Sabrina Hui-Xian Cheok, Salman Ahmed Abdul Jabbar, Neng-Wei Wong, James Chi-Yong Ngu, Nan-Zun Teo, Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
Author contributions: Cheok SHX drafted the article; Jabbar SAA, Wong NW, Ngu JCY, and Teo NZ were involved in the concept and design of the article, critical revision, and final approval.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nan-Zun Teo, Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. teo.nan.zun@singhealth.com.sg
Received: July 3, 2025 Revised: August 6, 2025 Accepted: October 9, 2025 Published online: December 27, 2025 Processing time: 174 Days and 20 Hours
Abstract
There is a lack of consensus on the optimal surgical approach for splenic flexure malignancies. Surgeons face the challenge of balancing successful oncological outcomes with the morbidity and functional effects of extended colonic resection, considering the variable ‘watershed’ vasculature and lymphatic anatomy of the splenic flexure. While there is an increasing body of evidence supporting the oncological safety of a more conservative segmental resection, most of the data stems from retrospective single center studies. This article reviews the management strategies and examines the evidence supporting various surgical approaches to splenic flexure malignancies.
Core Tip: There are several studies in current literature discussing the optimal surgical approach for splenic flexure malignancies. However, these studies are mainly retrospective and performed in single centers. The variability in the vascular and lymphatic anatomy of the splenic flexure coupled with the lack of international standardization in the terminology for oncologic resections makes management challenging. This article reviews the various management strategies in the literature and examines the evidence supporting various surgical approaches to splenic flexure malignancies.
