Left colectomies (LC) have been also used for distal transverse tumors near the splenic flexure and splenic flexure cancer (SFC) ( 12).The aim of the present narrative review is to describe the indications, outcomes, limitations and advantages of STC, ERC, LC, and TC for TCC in order to identify possible trends in the current literature suggesting which is the best treatment option in both elective and emergency settings.Ī literature search was conducted to identify studies focusing on the surgical treatment of TCC. The debate persists whether a subtotal colectomy (STC) or extended right colectomy (ERC) may achieve more complete mesocolic excision associated with higher lymph node harvesting, greater distance between the tumor and the central vascular tie, and ultimately, higher disease-free survival (DFS) and overall survival (OS) compared to more conservative approach, such as transverse colectomy (TC) ( 9, 11). These challenging aspects limited the widespread of the laparoscopic (LAP) approach in TCC and prevented the inclusion of this tumors in most of the previous randomized controlled trials. However, surgical expertise is required to perform, either by laparoscopy or open surgery, high middle colic artery (MCA) dissection with a complete transverse mesocolic excision ( 8- 10). Based on the abovementioned considerations, TCC resections should associate the excision of the entire transverse mesocolon. Due to close relationship between the transverse mesocolon and the proximal superior mesenteric artery (SMA) and vein, also with foregut structures (i.e., greater omentum, the lesser sac, pancreas) TCC may spread to the lymph nodes of the proximal SMA and vein, to the greater omentum, and to the lower border of the pancreas ( 5- 7). Anatomical peculiarities of the transverse colon are consequences of its central position between the foregut and midgut. Transverse colon cancer (TCC) represent less than 10% of all CRCs ( 3, 4). In Europe, there was an estimation of 500,000 new cases and 243,000 deaths from CRC in 2018 ( 2). Over 1.8 million new colorectal cancer (CRC) cases and 881,000 deaths were estimated to occur worldwide in 2018, when CRC was the third most commonly diagnosed cancer (10.2%) and the second leading cause of cancer death (9.2%) ( 1). Received: 15 April 2019 Accepted: 09 July 2019 Published: 31 July 2019.
Keywords: Transverse colon cancer (TCC) transverse colectomy (TC) extended colectomy (EC) subtotal colectomy (STC) The aim of the present review is to describe the outcomes, limitations and advantages of TC, ERC, and STC for TCC in order to identify possible trends in the current literature suggesting which is the best treatment option in both elective and emergency settings. Despite a lack of standardized definitions, three main surgical options are proposed: segmental colectomy of the transverse colon, extended right colectomy (ERC) and subtotal colectomy (STC). Moreover, mobilization of the transverse colon can be particularly challenging in comparison to other colon tracts. Lymphatic drainage and vascularization of this section of the colon is highly variable presenting with different anatomical variants. To date, there is still no consensus on which type of surgical resection perform in case of transverse colon cancer (TCC). The principle of oncological radicality includes primary tumor resection with adequate lymphadenectomy. #These authors contributed equally to this work.Ībstract: Transverse colon is an infrequent localization of colon cancer and it is burdened by a poor prognosis. Aleix Martínez-Pérez 1#, Elisa Reitano 2#, Paschalis Gavriilidis 3, Pietro Genova 2, Paolo Moroni 2, Riccardo Memeo 4, Francesco Brunetti 2, Nicola de’Angelis 2ġ Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain Ģ Unit of Digestive Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, Créteil, France ģ Department of General and Colorectal Surgery, Northampton General Hospital NHS Trust, Northampton, UK Ĥ Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, ItalyĬontributions: (I) Conception and design: N de’Angelis, A Martínez-Pérez (II) Administrative support: None (III) Provision of study materials or patients: E Reitano, P Genova, P Moroni (IV) Collection and assembly of data: E Reitano, P Genova, F Brunetti, R Memeo (V) Data analysis and interpretation: E Reitano, N de’Angelis, P Gavriilidis, A Martínez-Pérez, F Brunetti, R Memeo (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors.
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