الفهرس 
PATHOLOGY OF COLORECTAL CANCEROnly 14 pages are availabe for public view
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Abstract
C
olorectal cancer (CRC) is already the third leading cause of cancer death worldwide, and its incidence is steadily rising in developing nations. Also known as colorectal adenocarcinoma, CRC usually emerges from the glandular, epithelial cells of the large intestine. Cancer arises when specific epithelium cells acquire a series of genetic or epigenetic mutations that confer a selective advantage on them.
The transverse colon is an intraperitoneal structure entirely encased in the peritoneum and, therefore, the least fixed part of the colon. The proximal two-thirds of the transverse colon derives from the midgut and is perfused by the middle colic artery. The last third rises out of the hindgut and is supplied by the left colic artery. Because of this embryological junction, this “watershed” area is sensitive to ischemia. In addition, the transverse colon is attached to the greater omentum and is in close proximity to the upper abdominal organs, such as the liver, spleen, and stomach. These factors contribute to the belief that a transverse colectomy is a technically challenging procedure compared to a right or left colectomy. Consequently, transverse colectomies are often excluded from large prospective randomized controlled trials.
Surgery is a crucial point in the treatment of colonic tumors. The surgical approach for transverse colon cancer (TCC) involves technical difficulties and a high risk of complication because the area is sensitive to ischemia and is closely attached to the surrounding organs.
Consequently, this study aimed to compare the surgical and oncological outcomes between transverse colectomy and extended RT hemicolectomy for patients with tumors of the transverse colon.
This retrospective study was conducted at tertiary care hospitals at the department of surgery, Ain Shams University hospital, and Dar-Shefa Hospital from Mars 2022 till October 2022 and enrolled all patients who had been diagnosed with transverse colon cancer and operated on by transverse colectomy or extended right colectomy in the period between January 2012 to December 2016.
The current study revealed that 46 (73%) underwent extended hemicolectomy and 17 (27%) underwent transverse colectomy. There were no statistically significant differences between the studied groups regarding age and sex, with no statistically significant differences between the studied groups regarding AJCC TNM stages (p values = 0.858, 0.828), respectively.
Regarding the surgical margins and harvested lymph nodes, our study results revealed that Proximal and distal surgical margins were significantly longer in the extended group. Lymph nodes harvested were statistically significantly higher in the extended group, with a non-significantly less frequent anastomotic leak.
Regarding the postoperative period, our study results revealed that Postoperative diarrhea was significantly more frequent in the extended group, with no statistically significant differences regarding the recurrence and survival in the extended group at three and five years.
We concluded that Proximal and distal surgical margins statistically were significantly longer in the extended group, and Lymph nodes harvested were statistically significantly higher in the extended group with no significant difference as regards the anatomic leakage, recurrence, and three-year and five-year survival rate.
Both extended right hemicolectomy and transverse colectomy offer similar oncological outcomes for mid-transverse colon cancer. Extended right hemicolectomy might be associated with fewer postoperative complications of diarrhea than transverse colectomy. Therefore, well-designed prospective multicenter trials and RCTs with homogeneous parameters are needed to conclude.
CONCLUSION
As evident from the current study, as far as we know, our study sheds new light on the significant differences between transverse resection and extended right hemicolectomy.
Proximal and distal surgical margins were significantly longer in the extended group. Lymph nodes harvested were statistically significantly higher in the extended group with no significant difference as the high number of harvested lymph nodes in extended hemicolectomy may be deceptive and not of that draining the tumor.
Extended right hemicolectomy might be associated with postoperative diarrhea more than transverse colectomy.
There is also no statistical difference as regard anastomotic leakage, oncological (recurrence), or three-year and five-year survival rate.
RECOMMENDATIONS
The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes demonstrating the long-term functional and oncological outcomes of extended right hemicolectomy and transverse colectomy.
At end we can decide what the procedure of choice according to location of the tumor in transverse colon.
If the tumor located in proximal transverse colon close to the hepatic flexure we recommend Rt hemi colectomy.
If the tumor located in distal transverse colon close to the splenic flexure we recommend Lt hemi colectomy or subtotal colectomy according feasibility of surgery.
If the tumor located in mid transverse colon we recommend transverse colectomy.