Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, Turin, Italy.
Eur J Surg Oncol. 2020 Sep;46(9):1683-1688. doi: 10.1016/j.ejso.2020.01.006. Epub 2020 Mar 19.
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.
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.
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).
According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
横结肠癌（TCC）研究较少，由于其复杂性和潜在的高并发症发生率，TCC 病例通常被排除在大型前瞻性随机试验之外。TCC 的最佳手术方法尚未确定。本大型回顾性多中心意大利系列研究旨在探讨横结肠切除术和横结肠切除术的优缺点，以确定最佳手术方法。
这是一项回顾性队列研究，纳入了 2006 年至 2016 年期间在 28 家意大利结直肠手术高容量（每年 70 例以上）转诊中心接受节段性结肠切除术或扩大半结肠切除术（右半结肠或左半结肠）治疗的 TCC 中段患者。
研究共纳入 1529 例患者，其中 388 例行节段切除术，1141 例行扩大切除术。与扩大切除术组相比，节段切除术组的并发症发生率更高（30.1%比 23.6%；p=0.010）。在 42 例主要并发症中，吻合口漏的发生率更高（4.4%比 2.2%；p=0.020）。恢复结果也显示出统计学差异：首次排气时间（p=0.014）、首次下床活动时间（p=0.040）和总住院时间（p<0.001）在扩大切除术组显著缩短。即使两组的总生存无差异（95.1%比 97%；p=0.384），但节段切除术组 3 年无病生存率恶化（78.1%比 86.2%；p=0.001）。
根据我们的结果，对于 TCC，扩大右半结肠切除术在手术上似乎更安全，更具有肿瘤学有效性。
