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.

Although intracorporeal anastomosis has been demonstrated to be safe and effective after right colectomy, limited data are available about its efficacy after left colectomy for colon cancer located in splenic flexure. A multi-institutional audit was designed, including 92 patients who underwent laparoscopic left colectomy with intracorporeal anastomosis (IA) compared with 89 matched patients who underwent a laparoscopic left colectomy with extracorporeal anastomosis (EA). There was no significant difference in terms of age, sex, BMI, and ASA score between the two groups. Post-surgical history and stage of disease according to AJCC/UICC TNM were also similar. IA and EA groups demonstrated similar oncologic radicality in terms of the number of lymph nodes harvested (18.5 ± 9 vs. 17.5 ± 8.4; p = 0.48). Recovery after surgery was also better in patients who underwent IA, as confirmed by the shorter time to flatus in the IA group (2.6 ± 1.1 days vs. 3.4 ± 1.2 days; p < 0.001) and higher post-operative pain expressed in the mean VAS Scale in the EA group (1.7 ± 2.1 vs. 3.5 ± 1.6; p < 0.001). Laparoscopic left colectomy with intracorporeal anastomosis was associated with a lower rate of post-operative complications (OR 6.7, 95% CI 2.2-20; p = 0.001). However, when stratifying according to Clavien classification, the difference was consistently confirmed for less severe (class I and II) complications (OR 7.6, 95% CI 2.5-23, p = 0.001) but not for class III, IV, and V complications (OR 1.8, 95% CI 0.1-16.9; p = 0.59). Our results were consistent to hypothesize that a complete laparoscopic approach could be considered a safe method to perform laparoscopic left colectomy with the advantage of a guaranteed faster recovery after surgery. Further randomized clinical trials are needed to obtain a more definitive conclusion.

Although intracorporeal anastomosis appears to be safe in terms of postoperative complications and is potentially more effective in terms of recovery after surgery, further ad hoc randomized clinical trials are needed, given the heterogeneity of the data available in the current literature.

BackgroundRecently, it has been questioned if minimally invasive surgery for rectal cancer was surgically successful. We decided to perform a meta-analysis to determine if minimally invasive surgery is adequate to obtain a complete resection for curable rectal cancer.MethodsA systematic search pertaining to evaluation between laparoscopic and open rectal resection for rectal cancer was performed until 30th November 2016 in the electronic databases (PubMed, Web of Science, Scopus, EMBASE), using the following search terms in all possible combinations: rectal cancer, laparoscopy, minimally invasive and open surgery. Outcomes analyzed were number of clear Distal Resection Margins (DRM or DM), complete Circumferential Resection Margins (CRM) and complete, nearly complete and incomplete Total Mesorectal Excision (TME) and of patients who received laparoscopic or open treatment for rectal cancer.Results12 articles were included in the final analysis. The prevalence of successful surgical resection was similar between open and laparoscopic surgery. About distance from distal margin of the specimen, clear CRM and complete TME there were no statistically significant difference between the two groups (MD = -0.090 cm, p = 0.364, 95% CI -0.283, 0.104; OR = 1.032, p = 0.821, 95% CI 0.784, 1.360; OR = 0.933, p = 0.720, 95% CI 0.638, 1.364, respectively).The analysis of nearly complete TME showed a significant difference between the two groups (OR = 1.407, p = 0.006, 95% CI 1.103, 1.795), while the analysis of incomplete TME showed a non-significant difference (OR = 1.010, p = 0.964, 95% CI 0.664, 1.534).ConclusionsBy pooling together data from 5 RCTs and 7 nRCTs, we are able to provide evidence of safety and efficacy of minimally invasive surgery. Waiting for further randomized clinical trials, our results are encouraging to introduce laparoscopic rectal resection in daily practice.