Robotic, Laparoscopic, and Open Segmental Resection vs. Extended Colectomy for Transverse Colon and Splenic Flexure Cancers: A Systematic Review.

Colorectal cancer is among the most common cancers in the world. Transverse colon cancer (TCC) and splenic flexure colon cancer (SFCC) are less common entities and present distinct clinical and surgical challenges. There is still no consensus on the surgical treatment of TCC and SFCC, and the optimal extent of resection and lymph node dissection remains controversial. This study aims to evaluate whether segmental resections, performed via robotic, laparoscopic, or open approaches, provide perioperative safety and long-term oncologic outcomes comparable to those of extended colectomies in patients with TCC or SFCC. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were sought in the databases PubMed, the Cochrane Library, Embase, Google Scholar, Scopus, ScienceDirect, and Web of Science, using manual search queries, up to June 30, 2024. The seven included studies comprised 454 TCCs (78 robotic, 305 laparoscopic, 71 open) and 143 SFCC, which were directly comparable by approach (39 robotic, 104 laparoscopic). Two large datasets contributed a further 10,461 SFCC cases for extent-of-resection analysis (5,698 segmental; 4,763 extended resections). Extent was reported in 454 TCC cases, with 390 segmental and 64 extended resections. Mortality was <1% across all series with no technique-related differences. Minimally invasive robotic and laparoscopic approaches have comparable safety profiles, similar minor and major complication rates, equivalent R0 resection rates, and similar anastomotic leak rates. Robotic surgery offers slightly shorter hospital stays. Both techniques remain effective and feasible for colorectal cancer surgeries, with the robotic approach providing perioperative advantages in selected cases. Current evidence supports the safety and oncologic adequacy of both segmental and extended resections. Although robotic surgery may provide modest perioperative advantages, selection of the surgical approach should be individualized, with careful consideration of surgeon experience, cost implications, institutional capabilities, and tumor-specific anatomical factors to optimize patient outcomes.