M Milone1, M Degiuli2, M E Allaix3, C A Ammirati4, G Anania5, A Barberis6, A Belli7, P P Bianchi8, F Bianco7, C Bombardini5, M Burati9, D Cavaliere10, C Coco11, A Coratti12, R De Luca13, G De Manzoni14, P De Nardi15, M De Rosa16, P Delrio17, A Di Cataldo18, A Di Leo14, A Donini19, U Elmore15, A Fontana20, G Gallo21, S Gentilli22, S Giannessi23, G Giuliani8, L Graziosi19, M Guerrieri24, G Li Destri18, R Longhin6, M Manigrasso9, M Mineccia20, M Monni22, M Morino3, M Ortenzi24, F Pecchini25, C Pedrazzani26, M Piccoli25, S Pollesel27, S Pucciarelli28, R Reddavid2, D Rega17, M Rigamonti29, G Rizzo11, V Robustelli23, F Rondelli16, R Rosati15, F Roviello27, M Santarelli30, F Saraceno31, S Scabini4, G S Sica32, P Sileri31, M Simone13, L Siragusa32, S Sofia2, L Solaini10, A Tribuzi12, M Trompetto21, G Turri26, E D L Urso28, S Vertaldi9, A Vignali15, M Zuin28, M Zuolo29, D D'Ugo33, G D De Palma9. 1. Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy. Electronic address: milone.marco.md@gmail.com. 2. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy. 3. Department of Surgical Sciences, University of Turin, Turin, Italy. 4. Oncologic Surgical Unit, Hospital Policlinic San Martino, Genova, Italy. 5. Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Italy. 6. Unit of General and Hepatobiliopancreatic Surgery, Galliera Hospital, Genova, Italy. 7. Division of Surgical Oncology, Department of Abdominal Oncology, IRCCS Fondazione "G. Pascale", Naples, Italy. 8. Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy. 9. Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy. 10. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy. 11. Department of General Surgery, Sacred Heart Catholic University, Rome, Italy. 12. Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy. 13. Department of Surgical Oncology, National Cancer Research Center, Giovanni Paolo II Tumor Institute, Bari, Italy. 14. Department of Surgery, General and Upper GI, Surgery Division, University of Verona, Verona, Italy. 15. Division of Gastrointestinal Surgery, San Raffaele Scientific Institut, Milan, Italy. 16. Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy. 17. Colorectal Abdominal Surgery Division, IRCCS Fondazione "G. Pascale", Naples, Italy. 18. Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy. 19. Department of General and Emergency Surgery, University of Perugia, Perugia, Italy. 20. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy. 21. Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy. 22. Department of General Surgery, Maggiore della Carità Hospital, Novara, Italy. 23. Operative Unit of General Surgery, San Jacopo Hospital, Pistoia, Italy. 24. Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy. 25. Department of General and Emergency Surgery, Azienda Ospedaliera Universitaria Modena, Modena, Italy. 26. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of Colorectal Surgery, University of Verona, Verona, Italy. 27. Department of General Surgery and Surgical Oncology, University of Siena, Italy. 28. Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy. 29. Operative Unit of General Surgery, Valli del Noce Hospital, Cles, Trento, Italy. 30. Division of General and Emergency Surgery, Molinette Hospital, Turin, Italy. 31. Department of General Surgery, University of Rome Tor Vergata, Rome, Italy. 32. Department of Minimally Invasive and GI Surgery, Policlinico Tor Vergata, Rome, Italy. 33. Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
Abstract
INTRODUCTION: Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS: This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS: The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS: According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
INTRODUCTION:Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS: This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS: The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS: According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.