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. 2024 Apr 15:14:1244693.
doi: 10.3389/fonc.2024.1244693. eCollection 2024.

Short- and long-term outcomes after surgical treatment of 5918 patients with splenic flexure colon cancer by extended right colectomy, segmental colectomy and left colectomy: a systematic review and meta-analysis

Yu Cao #  1 , Mingze He #  2 , Kuo Chen  3 , Zheng Liu  4 , Denis I Khlusov  1 , Tatyana V Khorobrykh  1 , Xinren Cao  1 , Polina D Panova  1 , Sergey K Efetov  1 , Airazat M Kazaryan  1   5   6   7   8   9
Affiliations

Short- and long-term outcomes after surgical treatment of 5918 patients with splenic flexure colon cancer by extended right colectomy, segmental colectomy and left colectomy: a systematic review and meta-analysis

Yu Cao et al. Front Oncol. .

Abstract

Background: Colorectal cancer is among the most common cancers in the world, and splenic flexure colon cancer accounts for about 2-5% of them. There is still no consensus on the surgical treatment of splenic flexure colon cancer (SFCC), and the extent of surgical resection and lymph node dissection for SFCC is still controversial.

Aim: To compare the postoperative and long-term oncologic outcomes of extended right colectomy (ERC), segmental colectomy (SC) and left colectomy (LC) for SFCC.

Method: Up to March 2024, retrospective and prospective studies of ERC, SC, and LC for SFCC were searched through databases. Pooled weighted/standardized mean difference (WMD/SMD), odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated using a fixed effects model or random effects model, and meta-analysis was performed using Stata.

Results: This meta-analysis includes 5,918 patients from 13 studies with more lymph node harvest (OR:6.29; 95%Cl: 3.66-8.91; Z=4.69, P=0), more operation time (WMD: 22.53; 95%Cl: 18.75-26.31; Z=11.68, P=0), more blood loss (WMD:58.44; 95%Cl: 20.20-96.68; Z=2.99, P=0.003), longer hospital stay (WMD:1.74; 95%Cl: 0.20-3.29; Z=2.21, P=0.03), longer time to return to regular diet (WMD:3.17; 95%Cl: 2.05-4.30; Z=5.53, P=0), longer first flatus time (WMD:1.66; 95%Cl: 0.96-2.37; Z=4.61, P=0) in ERC versus SC. More lymph node harvest (WMD: 3.52; 95% Cl: 1.59-5.44; Z=3.58, P=0) in ERC versus LC and LC versus SC (WMD: 1.97; 95% CI: 0.53-3.41; Z=2.68, P=0.007), respectively. There is no significant difference between anastomotic leakage, postoperative ileus, total postoperative complication, severe postoperative complication, wound infection, reoperations, R0 resection, postoperative mortality, 5-year overall survival (OS), 5-year disease-free survival (DFS) in three group of patients. In LC versus SC and ERC versus LC, there is no difference between operation time, blood loss, hospital stay, return to regular diet, and first flatus.

Conclusion: In the included studies, SC and LC may be more advantageous, with fewer postoperative complications and faster recovery. ERC harvests more lymph nodes, but there is no significant difference in long-term OS and DFS between the three surgical approaches. Given that the included studies were retrospective, more randomized controlled trials are needed to validate this conclusion.

Keywords: colon cancer; colorectal surgery; extended right colectomy; left colectomysplenic flexure cancer; meta-analysis; segmental colectomy; splenic flexure colon cancer; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CONSORT flowchart.
Figure 2
Figure 2
Meta-analytic graphs of extended right colectomy versus segmental colectomy. 1. (A–E) Complications; 2. (A–E) Pathology and long-term survival; 3. (A–E) Outcomes.
Figure 3
Figure 3
Meta-analytic graphs of left colectomy versus segmental colectomy. 1. (A–F) Complications; 2. (A–E) Pathology and long-term survival; 3. (A–E) Outcomes.
Figure 4
Figure 4
Meta-analytic graphs of extended right colectomy versus left colectomy. 1. (A–E) Complications; 2. (A–E) Pathology and long-term survival; 3. (A–E) Outcomes.
See this image and copyright information in PMC

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References

    1. Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK, et al. . Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. (2021) 19(3):329–59. doi: 10.6004/jnccn.2021.0012 - DOI - PubMed
    1. Vogel JD, Felder SI, Bhama AR, Hawkins AT, Langenfeld SJ, Shaffer VO, et al. . The american society of colon and rectal surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum. (2022) 65:148–77. doi: 10.1097/DCR.0000000000002323 - DOI - PubMed
    1. Nakagoe T, Sawa T, Tsuji T, Jibiki M, Nanashima A, Yamaguchi H, et al. . Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery. J Gastroenterol. (2000) 35:528–35. doi: 10.1007/s005350070076 - DOI - PubMed
    1. Murono K, Miyake H, Hojo D, Nozawa H, Kawai K, Hata K, et al. . Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein. Colorectal Dis. (2020) 22:392–8. doi: 10.1111/codi.14886 - DOI - PubMed
    1. Andersen BT, Stimec BV, Edwin B, Kazaryan AM, Maziarz PJ, Ignjatovic D. ReiRe-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer. Surg Endosc. (2022) 36:100–8. doi: 10.1007/s00464-020-08242-8 - DOI - PMC - PubMed

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