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.

Autor:	Cao Y; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., He M; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Chen K; Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China., Liu Z; Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China., Khlusov DI; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Khorobrykh TV; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Cao X; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Panova PD; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Efetov SK; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Kazaryan AM; Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.; Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway.; Department of Surgery, Østfold Hospital Trust, Grålum, Norway.; Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.; Department of Surgery, Fonna Hospital Trust, Odda, Norway.; Department of Surgery No. 1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2024 Apr 15; Vol. 14, pp. 1244693. Date of Electronic Publication: 2024 Apr 15 (Print Publication: 2024).
DOI:	10.3389/fonc.2024.1244693
Abstrakt:	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. Competing Interests: 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. (Copyright © 2024 Cao, He, Chen, Liu, Khlusov, Khorobrykh, Cao, Panova, Efetov and Kazaryan.)
Databáze:	MEDLINE
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