Abstract
Due to special tumor location and technical difficulty of transverse colon cancer (TCC), partial colectomy (PC) is being widely applied in selected TCC patients, instead of extended hemicolectomy (HC). However, the oncological safety of this less aggressive surgical approach is not well studied. Here, we identified 10344 TCC patients from Surveillance, Epidemiology, and End-Results (SEER) database. The surgical treatment for those patients included PC and HC. Firstly, we compared lymph nodes evaluations between patients treated with HC and PC, including median number of nodes, the rate of nodes ≥ 12 and the rate of node positivity. Then, 5-year cancer specific survival (CSS) was obtained. Kaplan-Meier methods and Cox regression models were performed to assess the correlations between prognostic factors and long-term survival. Despite of less node examined by PC, the rate of node positivity was equal between PC and HC, suggesting node retrieval under PC was adequate to tumor stage. In addition, the 5-year CSS for patients who underwent PC were 67.5%, which was similar to patients who received HC (66.5%). The result after propensity score matching also confirmed the equivalent survival outcome between HC and PC. However, subgroup analyses showed that patients with tumor size ≥ 5 cm could not obtain survival benefit from PC. Furthermore, surgical approach was not considered as independent prognostic factor for TCC patients. Therefore, although PC is a less aggressive surgical approach, it should be a safe and feasible option for selected TCC patients.
Highlights
The transverse colon cancer (TCC) accounts for about 10% of all colorectal cancer [1]
A total of 10344 eligible TCC patients were collected during 10 years period, which included 4431 patients who underwent partial colectomy (PC) and 5913 patients who underwent HC
The TCC patients are not included in high quality studies, which have resulted in a lack of evidence-based guidelines of surgical treatment for TCC patients
Summary
The transverse colon cancer (TCC) accounts for about 10% of all colorectal cancer [1]. The surgical approach and the extent of lymph node dissection for CC depend on tumor location, extent of lymphatic spread and oncologic outcome. The central tumor location of TCC presented difficult surgical choices in determining appropriate surgical procedure and extent of lymphadenectomy, reconstruction of intestinal continuity, as well as technical difficulties regarding identification, ligation, and lymph node dissection around the middle colic vessels [5]. It is well acknowledged that HC is associated with larger extent of colon resection and more lymph nodes examined, which lead to more technical difficulties in surgical procedure. Regardless of difficulties on surgical technique, the major controversy about PC for TCC lies on whether or not it is feasible to perform sufficient extent of lymph node dissection and equivalent survival outcome compared with extended HC
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