Subtotal colectomy, extended right hemicolectomy, left hemicolectomy, or splenic flexure colectomy for splenic flexure t
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ORIGINAL ARTICLE
Subtotal colectomy, extended right hemicolectomy, left hemicolectomy, or splenic flexure colectomy for splenic flexure tumors: a network meta-analysis Xiaojie Wang 1 & Zhifang Zheng 1 & Min Chen 2 & Xingrong Lu 1 & Shenghui Huang 1 & Ying Huang 1 & Pan Chi 1 Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim To perform a network meta-analysis of the current literature to evaluate the short-term and long-term outcomes of four operations for splenic flexure tumors. Methods An electronic literature search of PubMed, Baidu Scholar, EMBASE, and Cochrane Central Register of Controlled Trials databases was performed up to August 2020. A Bayesian network meta-analysis was utilized to compare the outcomes involved in subtotal colectomy (STC), extended right hemicolectomy (ERHC), standard left hemicolectomy (LHC), and splenic flexure colectomy (SFC) by using R software. Results A total of 10 non-randomized studies were included in this meta-analysis. There was no statistically significant difference among these 4 surgical techniques in terms of the utilization rate of minimally invasive surgery, reoperative surgery, anastomotic dehiscence, mortality, the proportion of patients with the number of lymph nodes harvested ≥ 12, local recurrence, distant recurrence and overall survival. Although ERHC was associated with a higher risk of postoperative ileus (ERHC vs SFC, OR = 6.4, 95% CI 1.4–45.0, P = 0.019), it has an advantage of a higher rate of primary anastomosis (ERHC vs LHC, OR = 4.2, 95% CI 1.3–18.0, P = 0.019) and a non-significant trend for lower anastomotic dehiscence when compared with more restrict resections. Conclusion SFC, LHC, ERHC and STC for the curative resection of splenic flexure tumors provide similar survival. An individualized surgical plan considering both long-term and short-term outcomes is necessary to select the appropriate operations. Keywords Splenic flexure tumors . Network meta-analysis . Surgery . Postoperative complications . Overall survival
Xiaojie Wang, Zhifang Zheng and Min Chen contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03763-z) contains supplementary material, which is available to authorized users. * Ying Huang [email protected] * Pan Chi [email protected] 1
Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, Fujian 350001, People’s Republic of China
2
Department of Obstetrics, Fujian Provincial Maternity and Children’s Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
Colonic cancers arising at the splenic flexure are rare and represent only less than 10% of all colorectal cancers treated by surgery [1]. In our experience, resections of splenic flexure cancer were performed in 48 cases only, which accounted for 3.9% of the 1244 colon tumors operated in our center in the past 14 years [2]. Splenic flexure cancer locates on the border betwee
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