Comparison of extended right hemicolectomy, left hemicolectomy and segmental colectomy for splenic flexure colon cancer: a systematic review and meta‐analysis

Abstract

Aim The aim of this work was to compare the outcomes of extended right hemicolectomy (ERH), left hemicolectomy (LH) and segmental colectomy (SC) for the surgical management of splenic flexure tumours. Method In compliance with PRISMA statement standards, a systematic review was performed to identify all studies comparing outcomes of ERH, LH and SC for the surgical management of splenic flexure tumours. Primary outcomes included anastomotic leakage and all postoperative complications. The secondary outcomes included operative time, R0 resection, number of harvested lymph nodes, > 12 harvested lymph nodes, severe complications, postoperative mortality, paralytic ileus, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, 5year overall survival and 5-year disease-free survival. The ROBINS-I tool and GRADE system were used to assess the risk of bias and certainty of evidence, respectively. Results Analysis of 956 patients from seven observational studies showed that ERH was associated with more paralytic ileus than LH (OR 2.74, P = 0.002) and SC (OR 6.67, P < 0.0001) and the operative time was shorter in SC than in ERH (mean difference 25.48, P < 0.0001) and LH (mean difference À17.94, P = 0.0002). There were no differences between ERH, LH and SC in terms of anastomotic leakage, postoperative complications, R0 resection, severe complications, postoperative mortality, wound infection, pancreatic fistula, intra-abdominal abscess, need for reoperation, length of hospital stay, > 12 harvested lymph nodes, 5-year overall survival and 5-year disease-free survival. Conclusions The available evidence, limited to observational studies, suggests that there is no difference between ERH, LH and SC in terms of postoperative morbidity and mortality, lymph node yield and cancer survival. Randomized controlled trials are required for definite conclusions.

Comment on ‘Comparison of extended right hemicolectomy, left hemicolectomy, and segmental colectomy for splenic flexure colon cancer (SFC): a systematic review and meta‐analysis’

“…We read with great interest the systematic review and meta‐analysis by Hajibandeh and colleagues [1], and we congratulate them on their comprehensive analysis. The authors concluded that the outcomes of extended right hemicolectomy (ERH), left hemicolectomy (LH), and segmental colectomy (SC) were similar with respect to the surgical management of splenic flexure colon cancer (SFC).…”

Primary tumor resection improves prognosis of unresectable carcinomas of the transverse colon including flexures with liver metastasis: a preliminary population-based analysis

“…Besides, SCR for transverse colon cancer was associated with less ileus but higher anastomotic leak rates and lower lymph node yields, and similar hospital stay [ 69 ]. For splenic flexure cancer, there was no difference in morbidity and mortality, the rate of lymph node yields and survival rate between SCR and LCR groups [ 68 ], and the operation time and hospital stay were shorter [ 71 ]. However, there was still a lack of reports on SCR for hepatic flexure cancer.…”

Welti’s manoeuvre, ileal passage below the mesocolon in extended left hemicolectomy, with peritonization: an old revised trick also useful also in the laparoscopic era – a video vignette

“…Closing the mesenteric defect helps prevent the development of internal hernia. This is a rather rare complication, with a prevalence of 0.5% [3,4]. Despite being rare, this event should be kept in mind by the colorectal surgeon because it can potentially lead to bowel ischaemia or necrosis if herniated loops are trapped below the mesenteric defect, exposing the patient to high morbidity and mortality rates [5].…”