Background and Aim: While use of laparoscopic colorectal surgery has spread in the last two decades, application of it to transverse colon cancer, particularly in cases requiring radical lymph node dissection, is still controversial. This study was designed to retrospectively investigate the feasibility of laparoscopic colectomy with radical lymph node dissection for transverse colon cancer.
Patients and Methods: Seven hundred and twenty-four colorectal cancer patients with 737 lesions underwent laparoscopic surgery from 1998 to 2009 in our institution. Of them, 70 lesions located in the transverse colon and 63 associated with D2 or D3 radical lymph node dissection, excluding patients with simultaneous multiple lesions, were included in this study. Surgeries included right hemi-colectomy (RHC; 12 cases) and partial resection of the transverse colon either with mobilization of the splenic flexure (T-left; 13 cases) or without it (T-middle; 38 cases). D3 Lymph node dissection involved dissection of fatty tissue including lymph nodes around the root of the middle colic artery not related to division, while D2 dissection involved clipping and division of the left or right branch of the middle colic artery without exposing the root. Surgery involved the following: 4 or 5 ports were placed with 10mmHg CO2 pneumoperitoneum under general anesthesia. The transverse mesentery was extended using 2 threads placed on the colon 5-10 cm oral and anal to the lesion. These two threads were brought outside through both upper quadrants of the abdomen. This technique allows precise anatomical orientation for radical lymph node dissection around the middle colic artery. Results: Two conversions (1 massive bleeding and 1 unclear preoperative marking (tattoo) in T-middle) (3.2%) occurred in this series. Time of operation in the T-left group (209.5 min) was significantly longer than that in the T-middle group (180.1 min)(p<0.05). Estimated blood loss was similar among the three types of surgery. Four leakages were encountered in the T-middle group (10.2%), whereas no leakage occurred in the other two groups; however, this difference in incidence was not significant. The total incidence of leakage in laparoscopic transverse colon cancer surgery was 6.3%. Wound infection occurred in 5 patients and small bowel obstruction in 2 patients. Three recurrences (2 in liver and 1 in peritoneum) were encountered in curatively respected patients among all types of surgery during the 33.6-month follow-up period. Overall and disease-free survivals of all cases were 88.9% and 88.9% in stage I, 85.2% and 80.4% in stage II, and 100% and 90 % in stage III, respectively.
Conclusions: Although laparoscopic transverse colectomy featured a rather high incidence of leakage as a postoperative complication, especially in cases of partial resection in transverse colectomy without mobilization of the splenic flexure, and laparoscopic transverse colectomy with mobilization of the splenic flexure required a relatively long period of time to complete, the low conversion rate and favorable long-term outcomes observed indicate that this type of surgery is feasible.
Program Number: P104