LAUSR

Dear Editor, Isolated splenic metastasis from colorectal cancer is a very rare clinical entity found in less than 1% of all metastases, with only 43 cases reported in the literature. This rarity has been found in the context of widely disseminated disease [1]. The optimal therapeutic approach for these patients is still a matter of debate, but the data available in the literature show that surgery followed by chemotherapy seems to be the preferred treatment modality, giving an improvement in longterm survival [2]. However, standardized treatment has not yet been established. The role of laparoscopic surgery in the setting of splenic malignancies is controversial, but the indications are increasing over time [3]. Some workers have shown higher risks of peritoneal dissemination using this method, whereas others have shown low morbidity and mortality and significantly improved postoperative recovery compared with standard open splenectomy [3,4]. In Video S1 in the Supporting Information we report a case of synchronous isolated splenic metastases from an obstructing splenic flexure cancer in a 60yearold male patient who underwent temporary faecal diversion (decompressive caecostomy) followed by elective concomitant laparoscopic extended right hemicolectomy (ERH) and splenectomy. The patient then received 12 cycles of adjuvant chemotherapy (FOLFOX4 regimen) and no sign of tumour relapse was observed over a 26month followup. In this case, we demonstrate the feasibility, safety and benefits of a twostage operation for left malignant colonic obstruction. After consulting the multidisciplinary oncology team, we performed an ERH by taking into consideration the impaired trophism of the right colon following the preperforated caecum at presentation and the presence of caecostomy. Interestingly, a recent metaanalysis demonstrated no differences between ERH, left hemicolectomy and segmental colectomy for the surgical management of splenic flexure tumours in terms of oncological outcomes [5]. We provide our experience to enrich the literature of this rare clinical entity, although no definitive conclusions can be drawn concerning the best therapeutic approach. We believe it remains crucial to maintain a close postoperative followup to detect potential relapses and improve longterm survival. DERIVATIVE C AECOSTOMY – SURGIC AL TECHNIQUE