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Surgical management of adenocarcinoma of the transverse colon: What should be the extent of resection? | LitMetric

AI Article Synopsis

  • The transverse colon, originating from both the midgut and hindgut, presents unique surgical challenges due to its anatomy and the rarity of adenocarcinoma in this area.
  • Surgical procedures for treating transverse colon cancer often require extensive lymph node removal and may vary significantly based on the surgeon's preferences.
  • Recent studies suggest that less aggressive surgeries like transverse colectomy may be as effective as more radical procedures, indicating a need to reevaluate the approach to treating transverse colon cancers.

Article Abstract

Transverse colon, owing its origin to midgut and hindgut and harbouring a flexure at both ends, continues to pose a surgical challenge. When compared to the rest of the colon, transverse colon adenocarcinoma is relatively uncommon. These cancers usually present late and lie in close proximity to the stomach, omentum, and pancreas. Adequate lymphadenectomy entails dissection around and ligation of the middle colic vessels. Hence, resectional surgery for transverse colon carcinoma is considered difficult. This is more so because of the variation of arterial and venous anatomy. From this perspective, the surgeon is tempted to perform a more radical operation like extended right or left hemicolectomy to secure an adequate lymphadenectomy. Such a cancer has also been dealt with a more limited transverse colectomy with colo-colic anastomosis. For all these reasons, patients with transverse colon adenocarcinoma were excluded from randomised trials which compared laparoscopic resection with traditional open operation. Surgical literature is yet to establish a definite operation for transverse colon cancer and the exact procedure is often dictated by surgeon's preference. This is primarily because this is an uncommon cancer. The rapid adoption of laparoscopic operation favoured extended colectomy as transverse colectomy can be difficult by minimally invasive technique. However, in the recent past, cohort studies and meta-analyses have shown equivalent oncological outcome between transverse colectomy and extended colectomy. It is time to resurrect transverse colectomy and consider it equivalent to its radical counterpart for cancers around the mid-transverse colon.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832969PMC
http://dx.doi.org/10.1002/ags3.12380DOI Listing

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