AB045. SOH23ABS_146. Surgical management strategies for malignancies of the splenic flexure—a systematic review and meta-analysis
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AB045. SOH23ABS_146. Surgical management strategies for malignancies of the splenic flexure—a systematic review and meta-analysis

David Lennon1, John Mahon2, Éanna Ryan1, Odhrán Ryan1, Matt Davey2, Rory Kennelly1, Des Winter1, Ann Hanly1, Sean Martin1

1Department of Colorectal Surgery, St Vincent’s University Hospital, Dublin, Ireland; 2Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland

Background: Extended right (ERHC) or left hemicolectomy (LHC) are the traditional management for splenic flexure colorectal cancer (SF-CRC). Formal resections were advocated as the lymphatic drainage is poorly defined. Emerging evidence suggests that segmental splenic flexure colectomy (SFC) may be oncologically adequate. We conducted a network meta-analysis (NMA) to determine the optimal surgical approach to SF-CRC.

Methods: A systematic review was conducted from inception to the 30th of May 2022. NMA was performed using RStudio and Netmeta.

Results: A total of 13 studies, involving 6,176 patients (ERHC n=785; LHC n=1,527; SFC n=3,864) were included in the NMA. SFC had a shorter operation time [176.37 min, mean difference (MD) SFC vs. LHC 20.34 min 95% credible interval (CrI) 10.9, 29.97; SFC vs. ERHC 22.19 95% CrI 11.09, 33.29] but also had a lower average lymph node yield (LNY) with ERHC harvesting the most (MD 7.15, 95%: CrI 5.71, 8.60). ERHC had higher incidence of post-operative ileus [odds ratio (OR) 3.47, 95% CrI 1.11, 10.84]. There was no difference in overall survival [SFC vs. LHC hazard ratio (HR) 1.03, 95% CrI 0.76, 1.34; SFC vs. ERHC HR 1.18, 95% CrI 0.85, 1.58]. There was no difference in minimally invasive surgery, anastomotic leak or perioperative mortality rates, or length-of-stay.

Conclusions: SFC, LHC, ERHC are all acceptable for the curative resection of SF-CRC. While ERHC has a higher LNY, there is no difference in OS. SFC may allow for a shorter operation and improved bowel function postoperatively. Surgeon preference and personalizing patient care are the likely determining factors in the management of SF-CRC.

Keywords: Colorectal cancer (CRC); splenic flexure cancer; surgical resection; meta-analysis; general surgery

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-23-ab045
Cite this abstract as: Lennon D, Mahon J, Ryan É, Ryan O, Davey M, Kennelly R, Winter D, Hanly A, Martin S. AB045. SOH23ABS_146. Surgical management strategies for malignancies of the splenic flexure—a systematic review and meta-analysis. Mesentery Peritoneum 2023;7:AB045.

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