Robotic, Laparoscopic, and Open Segmental Resection vs. Extended Colectomy for Transverse Colon and Splenic Flexure...

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Transverse colon cancer (TCC) and splenic flexure colon cancer (SFCC) are uncommon, posing unique clinical and surgical challenges.
• Optimal surgical treatment, including extent of resection and lymph node dissection, remains debated for TCC and SFCC.

Purpose of the Study:

• To compare perioperative safety and long-term oncologic outcomes of segmental resections versus extended colectomies for TCC and SFCC.
• To evaluate robotic, laparoscopic, and open surgical approaches for these specific colorectal cancers.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Searched multiple databases (PubMed, Cochrane, Embase, etc.) up to June 30, 2024.
• Included seven studies with 454 TCCs and 143 SFCCs, plus large datasets for extent analysis.

Main Results:

• Mortality was <1% across all techniques with no significant differences.
• Minimally invasive robotic and laparoscopic approaches demonstrated comparable safety, complication rates, R0 resection, and anastomotic leak rates.
• Robotic surgery showed slightly shorter hospital stays; both segmental and extended resections are oncologically adequate.

Conclusions:

• Both segmental and extended colectomies are safe and oncologically sound for TCC and SFCC.
• Minimally invasive approaches (robotic, laparoscopic) are feasible and safe alternatives to open surgery.
• Individualized patient and tumor factors should guide surgical approach selection for optimal outcomes.