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TRANSVERSE COLECTOMY VERSUS EXTENDED RIGHT OR LEFT COLECTOMY FOR MID-TRANSVERSE COLON CANCER.
Lieve G. Leijssen*1,2, Anne M. Dinaux1,2, Hiroko Kunitake1,2, Liliana G. Bordeianou1,2, David L. Berger1,2
1General and Gastrointestinal Surgery, Massachusetts General Hospital, Somerville, MA; 2Harvard Medical School, Boston, MA
Introduction
The type of surgery performed for a primary transverse colon cancer varies, since transverse colon cancer is rare and the chosen procedure is often based on surgeon perspective. Long-term oncological outcomes following different surgical approaches has not been clearly established. We aim to determine if transverse colectomy impacts long-term oncological outcomes in comparison to extended right or left colectomy for a mid-transverse colon cancer.
Methods
All patients who underwent surgical treatment for a mid-transverse colon cancer at our tertiary center from 2004 to 2014 were included. We divided the patients in a transverse colectomy (TC) and an extended colectomy group, either right or left sided (EC). Patient characteristics, peri- and postoperative variables, and long-term outcomes were compared between these two groups.
Results
A total of 108 patients were included, of whom 50.9% underwent an EC (right 39.8% vs. left 11.1%) and 49.1% a TC. Patient demographics as well as clinical work-up were similar for both groups. The majority of the patients underwent an open resection (TC 84.9% vs. EC 85.5%). There was a tendency for a longer duration of surgery (130 vs. 157 minutes; P=0.220) and longer length of stay (5 vs. 6 days; P=0.137) for EC patients. Resection length was longer for EC (median 33 vs. 19 cm, P<0.01). Furthermore, pathology revealed significantly more lymphocytic transmural response in EC patients (P<0.05), and more lymph nodes harvested (P<0.001) with no differences in the number of positive lymph nodes. Microsatellite instability was significantly different, with more high microsatellite instability in EC patients and a tendency for more stable microsatellite instability in TC patients (P0.088). In addition, R0 resections were achieved more often in EC patients than TC patients (98.2% vs. 90.6%), and EC resections tend to have more tumors with ulcerative morphology and small vessel involvement, however this was not significant. Patients who underwent EC had significantly more 30-day morbidity (P<0.05), but no difference in 30-day mortality and long-term oncological outcomes were found. Neither was there a significant difference in Kaplan Meier curves for overall and disease free survival (P=0.966). For patients who underwent a TC, the Kaplan-Meier estimate of five-year survival was 67.2% versus 63.8% for EC patients.
Conclusion
Our study underlies the oncological safety of a transverse colectomy for mid-transverse colon cancer. Average length of stay and surgery duration were comparable between TC and EC patients. However, EC patients are associated with more lymph nodes harvested without more positive lymph nodes, and more complications during admission. This is despite the fact that there were more colo-colonic anastomoses in the patients who underwent a TC.
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