Transverse Colectomy Versus Extended Right or Left Colectomy for Mid-Transverse Colon Cancer
Lieve G.J. Leijssen, Anne M. Dinaux, Ramzi Amri, Hiroko Kunitake, Liliana G. Bordeianou, David L. Berger Division
Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
Background: Extended colectomy is often chosen for patients with transverse colon cancer. However, due to the low incidence of transverse lesions and the even lower proportion of transverse colectomies, the optimal surgical approach for mid-transverse colon cancer has not clearly been established.
Methods: We identified patients who underwent a transverse (TC) or an extended colectomy (EC) for mid-transverse colon cancer between 2004-2014.
Results: A total of 103 patients were included, of whom 63.1% underwent EC (right 46.6%, left 16.5%) and 36.9% TC. Patient demographics and short-term outcomes were comparable. Pathology revealed higher lymph node harvests, and more patients with high microsatellite instability (MSI-H) after EC, as well as non-significantly more lymphocytic reaction. Five-year overall survival (OS) was comparable (TC 78.8%, EC 73.5%). When comparing long-term outcomes stage-by-stage, a trend towards worse 5-year OS and disease-free survival (DFS) in EC patients was observed, however worse OS and DFS were seen in stage II. All stage II patients died of a non-cancer related cause and recurrence occurred in pT4 TC patients who did not receive adjuvant therapy.
Conclusion: Our study underlines the oncological safety of a transverse colectomy for mid-transverse colon cancer. Although EC tumors were associated with higher lymph node harvests, more lymphocytic reaction and MSI-H, long-term outcomes were comparable. 
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