Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis

de’Angelis, Nicola; Martínez-Pérez, Aleix; Winter, D. C.; Landi, Filippo; Vitali, Giulio Cesare; Roy, Bertrand Le; Coccolini, Federico; Brunetti, Francesco; Celentano, Valerio; Saverio, Salomone Di; Ris, Frédéric; Fuks, David; Espín, Eloy

doi:10.1007/s00464-020-07431-9

Cited by 41 publications

(96 citation statements)

References 46 publications

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“…There is no significant difference, however, in the numbers of patients with ASA grades of 3 or higher in either group. Two studies provided information on the type of anastomosis; however, data were insufficient for comparative analysis [2,14].…”

Section: Discussion and Con Clus I Onmentioning

confidence: 99%

“…Transverse colectomy was universally defined as resection of any length of bowel from hepatic to splenic flexure and included ligation of the middle colic pedicle at its origin [5,10-12]. Segmental colectomy for tumours of the distal transverse colon and splenic flexure was similarly defined as resection of a length of transverse colon and proximal descending colon with ligation of the supplying middle colic vessels at its origin and where required ligation of the left colic vessel[13,14]. Extended colectomy included both left and right extended colectomy[2,5,[10][11][12]14] and sub-total colectomy[13].…”

mentioning

confidence: 99%

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Segmental versus extended colectomy for tumours of the transverse colon: a systematic review and meta‐analysis

et al. 2020

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There is no consensus on the appropriate extent of oncological resection for tumours of the transverse colon. Concerns regarding tumour factors such as pattern of lymph node spread and technical factors such as anastomotic perfusion lead to a variety of procedures being performed. Operations such as sub-total colectomy, extended right hemicolectomy, left hemicolectomy, transverse colectomy and segmental resection are all frequently performed for tumours of similar location [1-5].

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Section: Discussion and Con Clus I Onmentioning

confidence: 99%

mentioning

confidence: 99%

Segmental versus extended colectomy for tumours of the transverse colon: a systematic review and meta‐analysis

et al. 2020

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“…Gravante 2016 [13] Martin Arevalo 2018 [11] Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2020 [ Test for overall effect: Z = 0.89 (P = 0.37) Heterogeneity: Chi 2 = 3.15, df = 4 (P = 0.53); I 2 = 0% Test for overall effect: Z = 0.59 (P = 0.56) Heterogeneity: Tau 2 = 519.85; Chi 2 = 19.68, df = 4 (P = 0.0006); I 2 = 80% Gravante 2016 [13] Martin Arevalo 2018 [11] Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2020 [ [14] de' Angelis 2016 [12] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] Rega 2019 [16] Rega 2019 [16] Rega 2019 [16] Rega 2019 [16] Total ( Odermatt 2014 [14] Odermatt 2014 [14] Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] Gravante Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [ Odermatt 2014 [14] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2016 [12] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] Rega Gravante 2016 …”

Section: Extended Right Hemicolectomy Versus Segmental Colectomymentioning

confidence: 99%

“…de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] de' Angelis 2020 [15] Rega Test for overall effect: Z = 1.48 (P = 0.14)…”

Section: Extended Right Hemicolectomy Versus Segmental Colectomymentioning

confidence: 99%

“…Heterogeneity: Tau 2 = 0.00; Chi 2 = 6.46, df = 3 (P = 0.09); I 2 = 54% [11] de' Angelis 2020 [15] de' Angelis 2020 [15] Rega de' Angelis 2020 [15] de' Angelis 2020 [15] Rega 2019 [16] Rega 2019 [16] Martin Arevalo 2018 [11] de' Angelis 2020 [15] Rega 2019 [16] Segmental colectomy versus left hemicolectomy Figure 5 highlights the results of analyses and outcome synthesis for the comparison of SC and LH.…”

Section: Extended Right Hemicolectomy Versus Segmental Colectomymentioning

confidence: 99%

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

et al. 2020

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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.

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Surgical management of adenocarcinoma of the transverse colon: What should be the extent of resection?

Roy

Kumar

2020

Annals of Gastroent Surgery

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Transverse colon, owing its origin to midgut and hindgut and harbouring a flexure at both ends, continues to pose a surgical challenge. When compared to the rest of the colon, transverse colon adenocarcinoma is relatively uncommon. These cancers usually present late and lie in close proximity to the stomach, omentum, and pancreas. Adequate lymphadenectomy entails dissection around and ligation of the middle colic vessels. Hence, resectional surgery for transverse colon carcinoma is considered difficult. This is more so because of the variation of arterial and venous anatomy. From this perspective, the surgeon is tempted to perform a more radical operation like extended right or left hemicolectomy to secure an adequate lymphadenectomy. Such a cancer has also been dealt with a more limited transverse colectomy with colo‐colic anastomosis. For all these reasons, patients with transverse colon adenocarcinoma were excluded from randomised trials which compared laparoscopic resection with traditional open operation. Surgical literature is yet to establish a definite operation for transverse colon cancer and the exact procedure is often dictated by surgeon's preference. This is primarily because this is an uncommon cancer. The rapid adoption of laparoscopic operation favoured extended colectomy as transverse colectomy can be difficult by minimally invasive technique. However, in the recent past, cohort studies and meta‐analyses have shown equivalent oncological outcome between transverse colectomy and extended colectomy. It is time to resurrect transverse colectomy and consider it equivalent to its radical counterpart for cancers around the mid‐transverse colon.

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Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis

Cited by 41 publications

References 46 publications

Segmental versus extended colectomy for tumours of the transverse colon: a systematic review and meta‐analysis

Segmental versus extended colectomy for tumours of the transverse colon: a systematic review and meta‐analysis

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

Surgical management of adenocarcinoma of the transverse colon: What should be the extent of resection?

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