Skip to main content

Advertisement

SpringerLink
Log in

Comparison of laparoscopic and open colectomy for splenic flexure colon cancer: a systematic review and meta-analysis

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study examined the short- and long-term outcomes of laparoscopic and open splenic flexure colon cancer (SFCC) surgery.

Method

Systematic literature searches were performed in PubMed and Ovid to compare laparoscopic and open colectomy for SFCC. The last search was conducted on November 7, 2021. Surgical and survival outcomes were collected and analyzed. This meta-analysis was performed using Review Manager Software (v 5.3).

Results

This study included seven publications with 2397 patients published between 2011 and 2021. A significant difference in operative time was seen in the laparoscopic group (P = 0.01, WMD = 50.13, 95%CI [10.32, 89.94], I2 = 97%); loss of blood estimated (P < 0.001, WMD =  −101.88, 95%CI [−161.65, −42.11], I2 = 82%) and the incidence of overall complications (P < 0.001, OR = 0.53, 95%CI [0.38, 0.75], I2 = 0%) of laparoscopic procedure were greatly decreased. There were similar results as compared in the two groups in terms of lymph node harvesting (P = 0.71, WMD = 0.49, 95%CI [−2.13, 3.12], I2 = 93%) and the distance of proximal (P = 0.50, WMD =  −1.09, 95%CI [−4.26, 2.08], I2 = 96%) or distal (P = 0.18, WMD = 2.44, 95%CI [−1.13, 6.01], I2 = 97%) resection margin. In addition, no significant differences were observed on overall/disease-free survival over 3/5 years between the two procedures. An analysis of subgroups that used propensity matching scores produced similar results.

Conclusion

The laparoscopic procedure is clinically safe and feasible for SFCC. It shows the advantages in decreasing intraoperative blood loss and overall complications, and the long-term survival outcomes would not be affected. Randomized clinical trials with a larger sample size are warranted in the future for further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin 71(3):209–249

    Article  Google Scholar 

  2. Jung F, Lee M, Doshi S et al (2021) Neoadjuvant therapy versus direct to surgery for T4 colon cancer: meta-analysis [J]. Br J Surg 109(1):30–36

    Article  Google Scholar 

  3. Manceau G, Alves A, Meillat H et al (2022) What is the optimal elective colectomy for splenic flexure cancer: end of the debate? A multicenter study from the GRECCAR group with a propensity score analysis [J]. Dis Colon Rectum 65(1):55–65

    Article  Google Scholar 

  4. Pedrazzani C, Turri G, Park SY et al (2020) Clinical-pathologic characteristics and long-term outcomes of left flexure colonic cancer: a retrospective analysis of an international multicenter cohort [J]. Dis Colon Rectum 63(12):1593–1601

    Article  Google Scholar 

  5. Degiuli M, Reddavid R, Ricceri F et al (2020) Segmental colonic resection is a safe and effective treatment option for colon cancer of the splenic flexure: a nationwide retrospective study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group [J]. Dis Colon Rectum 63(10):1372–1382

    Article  Google Scholar 

  6. Vogelsang RP, Fransgaard T, Falk Klein M et al (2021) Long-term oncological outcomes in patients undergoing laparoscopic vs. open surgery for colon cancer: a nationwide cohort study [J]. Colorectal Dis

  7. Toritani K, Watanabe J, Nakagawa K et al (2019) Randomized controlled trial to evaluate laparoscopic versus open surgery in transverse and descending colon cancer patients [J]. Int J Colorectal Dis 34(7):1211–1220

    Article  Google Scholar 

  8. Kitano S, Inomata M, Mizusawa J et al (2017) Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial [J]. Lancet Gastroenterol Hepatol 2(4):261–268

    Article  Google Scholar 

  9. Martínez-Pérez A, Brunetti F, Vitali GC et al (2017) Surgical treatment of colon cancer of the splenic flexure: a systematic review and meta-analysis [J]. Surg Laparosc Endosc Percutan Tech 27(5):318–327

    Article  Google Scholar 

  10. Wan X, Wang W, Liu J et al (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range [J]. BMC Med Res Methodol 14:135

    Article  Google Scholar 

  11. Pedrazzani C, Turri G (2021) Laparoscopic vs open surgery for left flexure colon cancer. A propensity score-matched analysis from an international cohort [J]

  12. Horsey ML, Sparks AD, Lai D et al (2021) Surgical management of splenic flexure colon cancer: a retrospective propensity-matched study comparing open and minimally invasive approaches using the national cancer database [J]. Int J Colorectal Dis

  13. Beghdadi N, Martinez-Perez A, Winter DC et al (2021) European multicenter propensity score match study of laparoscopic vs. open colectomy for splenic flexure carcinomas: results from the splenic flexure cancer (SFC) study group [J]. J Visc Surg 05

  14. Chi Z, Li Z, Cheng L et al (2018) Comparison of long-term outcomes after laparoscopic-assisted and open colectomy for splenic flexure cancer [J]. J buon 23(2):322–328

    PubMed  Google Scholar 

  15. Kim MK, Lee IK, Kang WK et al (2017) Long-term oncologic outcomes of laparoscopic surgery for splenic flexure colon cancer are comparable to conventional open surgery [J]. Ann Surg Treat Res 93(1):35–42

    Article  Google Scholar 

  16. Okuda J, Yamamoto M, Tanaka K et al (2016) Laparoscopic resection of transverse colon cancer at splenic flexure: technical aspects and results [J]. Updat Surg 68(1):71–75

    Article  Google Scholar 

  17. Nakashima M, Akiyoshi T, Ueno M et al (2011) Colon cancer in the splenic flexure: comparison of short-term outcomes of laparoscopic and open colectomy [J]. Surg Laparosc Endosc Percutan Tech 21(6):415–418

    Article  Google Scholar 

  18. Kim CW, Shin US, Yu CS et al (2010) Clinicopathologic characteristics, surgical treatment and outcomes for splenic flexure colon cancer [J]. Cancer Res Treat 42(2):69–76

    Article  Google Scholar 

  19. Anania G, Arezzo A, Davies RJ et al (2021) A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision [J]. Int J Colorectal Dis 36(8):1609–1620

    Article  Google Scholar 

  20. Wu Q, Wei M, Zhang X et al (2021) Distinctive features of small vessels on the mesorectal and parietal pelvic fascia as important landmarks in guiding precise inter-fascial dissection for low rectal cancer [J]. Surg Endosc

  21. Pedrazzani C, Park SY, Conti C et al (2021) Analgesic efficacy of pre-emptive local wound infiltration plus laparoscopic-assisted transversus abdominis plane block versus wound infiltration in patients undergoing laparoscopic colorectal resection: results from a randomized, multicenter, single-blind, non-inferiority trial [J]. Surg Endosc 35(7):3329–3338

    Article  Google Scholar 

  22. Hoffman T, Shitrit P, Chowers M (2021) Risk factors for surgical site infections following open versus laparoscopic colectomies: a cohort study [J]. BMC Surg 21(1):376

    Article  Google Scholar 

  23. Díaz-Vico T, Fernández-Hevia M, Suárez-Sánchez A et al (2021) Complete mesocolic excision and D3 lymphadenectomy versus conventional colectomy for colon cancer: a systematic review and meta-analysis [J]. Ann Surg Oncol 28(13):8823–8837

    Article  Google Scholar 

  24. Murono K, Nozawa H, Kawai K et al (2021) Vascular anatomy of the splenic flexure: a review of the literature [J]. Surg Today

  25. Cheruiyot I, Cirocchi R, Munguti J et al (2021) Surgical anatomy of the accessory middle colic artery: a meta-analysis with implications for splenic flexure cancer surgery [J]. Colorectal Dis 23(7):1712–1720

    Article  Google Scholar 

  26. Andersen BT, Stimec BV, Edwin B et al (2022) Re-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 [J]. Surg Endosc 36(1):100–108

    Article  Google Scholar 

  27. Iguchi K, Mushiake H, Hasegawa S et al (2021) Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography [J]. Int J Colorectal Dis 36(2):405–411

    Article  CAS  Google Scholar 

  28. Manceau G, Mori A, Bardier A et al (2018) Lymph node metastases in splenic flexure colon cancer: is subtotal colectomy warranted? [J]. J Surg Oncol 118(6):1027–1033

    Article  Google Scholar 

  29. Chenevas-Paule Q, Trilling B, Sage PY et al (2020) Laparoscopic segmental left colectomy for splenic flexure carcinoma: a single institution experience [J]. Tech Coloproctol 24(1):41–48

    Article  CAS  Google Scholar 

  30. Di Saverio S, Stasinos K, Stupalkowska W et al (2021) Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels [J]. Langenbecks Arch Surg

  31. Li Destri G, Barchitta M, Agodi A et al (2019) Predictive value of the number of harvested lymph nodes and cut-off for lymph node ratio in the prognosis of stage II and III colorectal cancer patients [J]. J Invest Surg 32(1):1–7

    Article  Google Scholar 

  32. Mechera R, Schuster T, Rosenberg R et al (2017) Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: a systematic review and meta-analysis [J]. Eur J Cancer 72:84–94

    Article  Google Scholar 

  33. Wu Z, Zhang S, Aung LH et al (2012) Lymph node harvested in laparoscopic versus open colorectal cancer approaches: a meta-analysis [J]. Surg Laparosc Endosc Percutan Tech 22(1):5–11

    Article  Google Scholar 

  34. Huynh C, Minkova S, Kim D et al (2021) Laparoscopic versus open resection in patients with locally advanced colon cancer [J]. Surgery 170(6):1610–1615

    Article  Google Scholar 

  35. You K, Park HC, Park SC et al (2021) Laparoscopic approach for T4 colon cancer can be associated with poor prognosis in right-sided T4b tumours [J]. Eur J Surg Oncol 47(7):1645–1650

    Article  Google Scholar 

  36. Ballabio M, Boni L, Baldari L et al (2020) Laparoscopic en bloc resection of T4b splenic flexure cancer with infiltration of the stomach and tail of the pancreas - a video vignette [J]. Colorectal Dis 22(2):225–226

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Surgery, Cancer Center, Department of Colorectal Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China

    Jini Wu, Shiliang Tu, Boan Zheng & Bingchen Chen

  2. Wujiaqu Modern Anorectal Hospital of the Sixth Division of Xinjiang Production and Construction Corps, Wujiaqu, China

    Bo Li

Authors
  1. Jini Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bo Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiliang Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Boan Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bingchen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bingchen Chen.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, J., Li, B., Tu, S. et al. Comparison of laparoscopic and open colectomy for splenic flexure colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 37, 757–767 (2022). https://doi.org/10.1007/s00384-022-04127-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-022-04127-5

Keywords

Search

Navigation