Medicine · 4 authors, 1 centre
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This meta-analysis of 15 studies (1,867 patients) compared surgical approaches for splenic flexure colon cancer. Laparoscopic surgery significantly reduced hospital stay, blood loss, postoperative complications, and time to oral diet compared to open surgery, with no difference in anastomotic leakage or infection. Extended right colectomy (ERC) harvested more lymph nodes than left colectomy (LC), but other outcomes were similar between the two approaches.
**Background:** Splenic flexure adenocarcinomas represent 2% to 8% of surgically treated colorectal cancers and carry a poor prognosis due to frequent obstruction, advanced stage at presentation, and lymphatic invasion. Surgical resection is technically challenging due to variable vascular anatomy and proximity to the pancreas and spleen. The optimal surgical approach—laparoscopic vs open, and extended right colectomy (ERC) vs left colectomy (LC)—remains debated. This meta-analysis aimed to evaluate the impact of these different surgical techniques on clinical and oncological outcomes.
**Methods:** A systematic search of OVID, Cochrane Library, Embase, PubMed, and Google Scholar was conducted through October 2022. Inclusion criteria were retrospective, prospective, or cohort studies comparing surgical techniques for splenic flexure colon cancer. Fifteen studies with a total of 1,867 subjects were included. Outcomes were analyzed using a random-effects model, calculating mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was assessed using the Q test and I² statistic. Publication bias was evaluated using rank correlation and regression tests.
**Key Results:**
*Open vs Laparoscopic Surgery (8 studies):* - Postoperative complications: Significantly lower in laparoscopic group (MD = 0.60; 95% CI: 0.27–0.93; P < .001). - Anastomotic leakage: No significant difference (MD = 0.54; 95% CI: 0.20–1.27; P = .15). - Surgical site infection: No significant difference (MD = 0.59; 95% CI: −0.25 to 1.34; P = .17). - Time to oral diet: Significantly shorter in laparoscopic group (MD = 0.82; 95% CI: 0.42–1.23; P < .001). - Length of hospital stay: Significantly shorter in laparoscopic group (MD = 0.82; 95% CI: 0.40–1.24; P < .001). - Operation time: No significant difference (MD = −1.44; 95% CI: −2.91 to 0.03; P = .054). - Blood loss: Significantly lower in laparoscopic group (MD = 1.34; 95% CI: 0.55–2.12; P < .001).
*ERC vs LC (7 studies):* - Harvested lymph nodes: Significantly higher in ERC group (MD = 0.37; 95% CI: 0.17–0.57; P = .001). - Operation time: No significant difference (MD = 0.12; 95% CI: −0.31 to 0.54; P = .59). - Hospitalization time: No significant difference (MD = 0.02; 95% CI: −0.21 to 0.25; P = .88). - R0 resection: No significant difference (MD = 0.52; 95% CI: −1.07 to 2.10; P = .52). - Anastomotic leakage: No significant difference (MD = 0.14; 95% CI: −0.53 to 0.81; P = .68). - Reoperation: No significant difference (MD = 0.12; 95% CI: −0.58 to 0.82; P = .74). - Mortality: No significant difference (MD = 0.65; 95% CI: −0.49 to 1.80; P = .26). - Postoperative complications: No significant difference (MD = 0.09; 95% CI: −0.28 to 0.47; P = .62).
*Neoadjuvant Therapy:* Four studies (including 1 RCT) suggested a beneficial impact on overall survival, though limited data precluded subgroup analysis.
**Clinical Implications:** Laparoscopic surgery for splenic flexure colon cancer offers significant short-term benefits over open surgery, including reduced hospital stay, blood loss, postoperative complications, and faster return to oral diet, without increasing anastomotic leakage or surgical site infection. Between ERC and LC, the only significant difference was a higher lymph node harvest with ERC, which may have oncological relevance. The choice between ERC and LC should consider individual patient anatomy and tumor characteristics. Neoadjuvant therapy may improve survival, particularly in T4 disease, but further research is needed. The authors note that only one included study was a randomized clinical trial, and call for multicenter future studies.