Our study underlines the oncological safety of a transverse colectomy for mid-transverse colon cancer. Although TC tumors were associated with poorer histopathological features, survival rates were comparable.

Background and Objectives: Vascular invasion, in particular extramural venous invasion (EMVI), is a pathologic characteristic that has been extensively studied in rectal cancer but rarely in colon cancer. This study aims to evaluate its prognostic role in stage II-III colon cancer. Methods: All stage II-III colon cancer patients who underwent surgery between 2004–2015 were reviewed. We divided the study group into patients without invasion, with intramural invasion only (IMVI), EMVI only, and both IMVI/EMVI (n=923). Results: EMVI was associated with other high-risk features, including T4, N+ disease, lymphatic, and perineural invasion (P<0.001). EMVI+ patients had considerably higher rates of locoregional and distant recurrence and subsequently disease-specific mortality (stage-II: odds ratio (OR) 3.64, P=0.001, stage-III OR:1.94, P=0.009), whereas outcomes were comparable between IMVI and no vascular invasion (OR:1.21, P=0.764, OR:1.28, P=0.607, respectively). The adjusted hazard ratios for EMVI+ patients on disease-free survival, and disease-specific survival were 2.07 (P<0.001), 1.67 (P=0.027), respectively. Moreover, EMVI+ stage-II patients fared worse than EMVI– stage-III patients, even after adjusting for adjuvant chemotherapy. Conclusion: EMVI is a strong predictor for worse oncologic outcomes in stage II-III colon cancer patients, whereas IMVI is not. It is also associated with worse outcomes compared in patients with higher stage disease who are EMVI negative.

This SSI risk assessment factor provides a simple tool using readily available characteristics to stratify patients by SSI risk and identify patients at risk during their postoperative admission. Thereby, it can be used to potentially focus frequent monitoring and more aggressive preventive efforts on high-risk patients.