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ONCOLOGICAL OUTCOMES OF TRANSVERSE COLON CANCER: A COMPREHENSIVE COMPARISON OF TRANSVERSE VS. EXTENDED COLECTOMY USING THE SEER DATABASE
Metincan Erkaya
*1, Cigdem Benlice
2, Emre Gorgun
1, Bilgi Baca
21Cleveland Clinic, Cleveland, OH; 2Acibadem University, ISTANBUL, Turkey
Background Surgical treatment for transverse colon cancer remains debated, depending on the surgeon's perspective. The aim of this large retrospective investigated the comparative long-term oncological outcomes of extended colectomy (EC) versus segmental colectomy (SC) in patients with transverse colon adenocarcinoma.
Methods Patients diagnosed with histopathological stage I-III transverse colon adenocarcinoma who underwent colectomy between 2013 and 2019 were identified from the Surveillance, Epidemiology, and End Results database. Patients were categorized into two distinct surgical groups based on SEER surgical approach codes: segmental colectomy (SC; Code 30: "partial colectomy, segmental resection") and extended colectomy (EC; Codes 40: "subtotal colectomy/hemicolectomy involving a portion of the transverse colon" and 50: "total colectomy from the cecum to the rectosigmoid junction"). Propensity score (nearest) matching was used to adjust for confounding variables including age, sex, stage, grade, and chemotherapy received, ensuring a more accurate comparison of survival outcomes.
Results We analyzed 18,799 patients with Stage I-III transverse colon adenocarcinoma, with 58% undergoing extended colectomy. Patients undergoing EC were more likely to have advanced-stage disease and receive chemotherapy (26% vs. 23%, p<0.01). After propensity score matching of 7,904 patients in each group, EC demonstrated a higher lymph node retrieval rate (94% vs. 89% with >12 nodes, p<0.01). Survival analysis revealed minimal differences: 5-year overall survival was 65.6% for EC versus 66.9% for SC (p=0.074), and cancer-specific survival was 81.7% versus 84.3% (p<0.01), respectively.
Conclusion This large national cohort study demonstrates that segmental colon resection for transverse colon cancers achieves comparable overall and cancer-specific survival compared to extended colon resections despite less lymph node harvest. These findings support a conservative approach, emphasizing patient factors, tumor characteristics, and quality of life in surgical decision-making.
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