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Laparoscopic Hemicolectomy vs Laparoscopic Transverse Colectomy
assisted, transverse colectomy, extended right hemicolectomy, transfusion. Pain is considered a severe complication if the patient
or extended left hemicolectomy. All patients were admitted and needs high dose of analgesia. We defined anastomotic leakage as
operated in the General Surgery Department, Zagazig University any clinical or radiological evidence of dehiscence which needs or
Hospitals, in the period between January 2015 and April 2020. not surgical intervention.
Mid-transverse colon cancer is the term used when the cancer Patients were allowed to exit from the hospitals in the case
is determined during surgical exploration to be found in the middle of absence of symptoms, regular stool passage, and meals’
part of the transverse colon, about 10 from each of the splenic or tolerance.
hepatic flexures.
Oncological and Follow-up Findings
Inclusion Criteria We followed our patients at the outpatient clinic during the first
Patients aged from 20–70 years with clinical, radiological, and 2 years after operation every 3 months; then, we followed them
histopathological diagnoses of adenocarcinoma of the transverse every 6 months for the remaining 3 years.
colon stages from I to III are included for the research. During the follow-up period, we regularly measured carcino-
embryonic antigen (CEA) and cancer antigen (CA19-9), we performed
Exclusion Criteria computed tomography of the abdomen and chest every 6 months,
We excluded patients with stage IV colon cancer who primarily and we performed total colonoscopy every 2 years. We assessed and
presented with distant metastases; patients with multiple foci of analyzed overall survival (OS), progression-free survival (PFS), and
colon cancer; patients with concomitant cancer in other organs; disease-free survival (DFS) rates during the follow-up.
patients with emergent surgical intervention for the management We performed a separate analysis for comparison between both
of cancer-related intestinal obstruction, severe bleeding, or hemicolectomy and transverse colectomy groups.
perforation; and patients with inflammatory bowel diseases or
familial adenomatous polyposis. Data Analysis
After the application of inclusion and exclusion criteria of the Clinical data, demographic data, pathological findings, operative,
current study, we included 120 cases with mid-transverse colon postoperative, and follow-up data were collected, tabulated,
cancer. We divided them into two groups: the first group included and statistically analyzed. We compared continuous data using
80 patients who were managed by right or left hemicolectomy Student’s t-test or Mann–Whitney U-test whenever needed. We
and the second group included 40 patients who were managed analyzed categorical data using either Chi-square or Fisher’s exact
by transverse colectomy. tests. For estimation of survival rates such as OS, PFS, and DFS rates,
Patients selected to perform transverse colectomy, right or left we used Kaplan–Meier curves and the log-rank test for comparison
hemicolectomy, were made according to the choice and evaluation between survival curves. Statistical analyses were two sided, and
of the surgeon. we considered p value of less than 0.05 as a significant value. We
used the statistical program Advanced Statistics (IBM SPSS Statistics
Surgical Techniques 5 v20.0, IBM Corporation, Armonk, New York).
We performed surgery by using five ports, and we performed
lymphadenectomy in a caudal-to-cranial or cranial-to-caudal results
manner along the superior mesenteric vein. We pulled out the
intestine from a minute incision and then transected it by linear Demographic and Clinical Results
staplers in all included patients. Table 1 denoted that there were no statistically significant
For cases that underwent hemicolectomy whether right or differences in both groups regarding all demographic patients’
left, we ligated that middle colic vessels at their origin for right data such as age, sex, and BMI and pathological findings such as
hemicolectomy and ligated the left colic and the left branch of the tumor histopathological subtype, grade, and stage.
middle colic pedicles at their origins for left hemicolectomy with There was a statistically significant difference in the length of
D2 or D3 lymphadenectomy. specimens, lengths of proximal and distal margins between both
For cases that underwent transverse colectomy, we have groups; they were longer in the hemicolectomy group than in the
resected the bowel segment located between both hepatic flexure transverse colectomy group (p = 0.007). The numbers of dissected
and splenic flexure, in addition to its lymphatic and vascular lymph nodes were significantly higher in the hemicolectomy group
supply that is located along the pedicle of middle colic vessel with than in the transverse colectomy group (p <0.001). The numbers
its ligation at its origin with D2 or D3 lymphadenectomy. Then, of positive lymph nodes were higher in the hemicolectomy group
restoration of the bowel was done by side-to-side or end-to-end than in the transverse colectomy group, but this was not statistically
anastomoses. significant (Tables 2 to 4).
We recorded all demographic patients’ data such as age, sex,
and BMI; pathological findings such as tumor histopathological Operative and Perioperative Results
subtype, grade, stage, number of dissected and positive lymph The duration of operative time was longer in the hemicolectomy
nodes, specimen length, and distances from both proximal and group than in the transverse colectomy group (p <0.001). There
distal resected margins; operative findings such as operative time, were no statistically significant differences in both groups regarding
complications, bleeding, and conversion rate; and postoperative conversion rates.
data such as postoperative pain, bleeding, surgical wound infection, The group of patients in the hemicolectomy group experienced
intestinal obstruction, and anastomotic leakage. a higher rate of recovery findings such as shorter time to first flatus,
Postoperative complications were defined as any adverse time to first mobilization, and shorter time to first meal, and shorter
findings that happened during 30 days from surgery. Bleeding was duration of hospital stay than those in the transverse colectomy
considered as a complication if the bleeding patient needs a blood group (0.014).

216 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)