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

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

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).

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.

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.