Transverse Colon Cancer: Are There Differences Depending on Location and Extent of Surgery?

Abstract

Introduction: Recent studies suggest that segmental and extended resections for transverse colon cancer (TCC) have similar oncologic outcomes. We aimed to compare TCC’s short- and long-term outcomes according to tumor location and surgical resection. Methods: Patients with pathological stages I-III TCC operated on electively between 2000 and 2012 were identified. Patient characteristics, perioperative and oncologic outcomes were compared. Results: A total of 242 patients [60 hepatic flexure cancer (HFC), 51 splenic flexure cancer (SFC), and 131 mid-transverse cancer (MTC)] met the inclusion criteria. No difference was observed in age (p = 0.80), gender (p = 0.08), BMI (p = 0.41), American Society of Anesthesiologists score (p = 0.35), use of laparoscopy (p = 0.52), pathologic stage (0.50), length of hospital stay (p = 0.23), and postoperative complication (p = 0.38) between the different cancer location cohorts. 96.7% and 76.3% of HFC and MTC patients underwent extended right colectomy. 64.7% of SFC patients underwent extended left colectomy (p < 0.001). 7.8% and 9.9% of SFC and MTC patients underwent segmental colon resection. Although no difference was observed in overall survival (64% vs 63% vs 67%, p = 0.59), and disease-free survival (59% vs 58% vs 66%, p = 0.61) between HFC, MTC, and SFC patients, the patients who underwent segmental colon resection had worse overall survival (45% vs 67% vs 63% vs 72%, p = 0.02), worse disease-free survival (45% vs 64% vs 59% vs 70%, p = 0.054), and less harvested lymph nodes (19.1±12.8 vs 28.2±19.1 vs 32.0±19.3 vs 59.5±42.0, p < 0.001) when compared with extended left, extended right, and total abdominal colectomy respectively. Conclusion: Extended resection should be the preferred treatment for transverse colon cancer, independently from its location.