Short- and long-term outcomes after transverse versus extended colectomy for transverse colon cancer. A systematic review and meta-analysis

Background: Provide the surgeon with a tool to decide the best surgical approach to transverse colon cancer. Objective: To compare the surgical and oncological outcomes between transverse colectomy and extended hemicolectomy for patients with tumours of the transverse colon. Data sources: A systematic search was performed in the electronic databases (PubMed, Web of Science, Scopus, EMBASE), using the following search terms and/or MeSH terms in all possible combinations: transverse, transversus, colectomy, hemicolectomy, segmental resection, transverse colon cancer. The last search was performed on 10 May 2018. Study selection: Two independent authors (Mi.M. and N.V.) analysed each article and performed the data extraction independently. In case of disagreement, a third investigator was consulted (Ma.M.). Discrepancies were resolved by consensus. Data extraction and synthesis: Data regarding sample size, major clinical and demographic variables, oncologic outcomes and postoperative recovery and complications were extracted. Main outcome measures: Main outcomes analysed were anastomotic leakage, early mortality, hospital stay, operative time, overall complications rate, wound infection, harvested nodes and disease-free survival. Results: No statistical differences were found between transverse colectomy and extended hemicolectomy in short- and long-term outcomes; our results revealed no differences in disease-free survival between the two surgical approaches. As expected, a statistically significant difference was found in favour of extended hemicolectomy in terms of number of harvested lymph nodes. Conclusions: This systematic review with meta-analysis focus on the two major approaches to transverse colon cancer. The reviewed evidence suggests that a conservative approach to transverse colon cancer is feasible and safe and oncological outcomes are comparable between a conservative and an extended surgical procedure.