The Challenge of the Transverse Colon Tumor: Laparoscopic Techniques and Strategies

Abstract

Laparoscopic techniques for colon cancer resections have significant benefits over open techniques as evidenced by earlier return of bowel function, shorter length of stay, and reduced postoperative pain. In recent years, enhanced recovery after surgery (ERAS) protocols have dramatically changed the perioperative care of surgical patients by reducing morbidity and mortality while at the same time reducing healthcare cost and patient length of stay. The incidence of transverse colon and splenic flexure tumors is lower than that of right- and left-sided colon cancer. At the same time, the prognosis of transverse colon tumors is also significantly poorer compared to left-sided and right-sided colon cancers. The reason for this difference is not completely known; however, it is postulated that due to the late presentation of symptoms and proximity to other organs such as the stomach, liver, gallbladder, and pancreas, the symptoms are misdiagnosed. Until recently, the laparoscopic approach to transverse colon cancer had not been well studied. Previous research comparing open to laparoscopic colectomy for cancer had excluded transverse colon tumors due to the increased difficulty of laparoscopic lymph node dissection around the middle colic artery and vein, as well as the proximity of the transverse mesocolon to structures such as the duodenum, pancreas, spleen, and the superior mesenteric artery (SMA).