Purpose This study aimed to evaluate the significance of transverse colon cancer as a predictor of locoregional recurrence in patients with stage III colon cancer.
Methods This single-center retrospective cohort study included 1,302 patients who underwent curative-intent laparoscopic colectomy for stage III colon cancer between 2003 and 2021. The primary outcome was locoregional recurrence, defined as tumor recurrence near the anastomotic site, regional lymph nodes, or peritoneal recurrence around the primary tumor. Multivariate analyses were conducted to identify the factors associated with locoregional recurrence.
Results Transverse colon cancer was identified in 151 patients (11.6%). Baseline characteristics were similar, but transverse colon cancer exhibited a higher locoregional recurrence rate than nontransverse colon cancer (7.9% vs. 2.0%, P<0.001). In transverse colon cancer, locoregional recurrence did not differ according to high ligation of the mid-colic vessel (without high ligation, 10.6% vs. high ligation, 6.7%; P=0.517), and 10 of 12 recurrences (83.3%) occurred predominantly in the regional lymph nodes. In multivariate analysis, transverse colon (hazard ratio [HR], 4.513; 95% confidence interval [CI], 2.226–9.154; P<0.001) and N2 category (HR, 2.044; 95% CI, 1.034–4.042; P=0.040) emerged as independent predictors of locoregional recurrence. Disease-free survival (73.8% vs. 79.2%, P=0.217) and overall survival (84.7% vs. 86.3%, P=0.735) in 5 years were not different between transverse and nontransverse colon cancer.
Conclusion Transverse colon cancer may serve as an independent predictor of locoregional recurrence in stage III colon cancer. The predominance of regional lymph node recurrence emphasizes the importance of careful regional lymph node assessment in transverse colon cancer.
Purpose Anastomotic leakage (AL) is a serious complication of rectal cancer surgery, and a properly positioned pelvic drain may aid early detection and conservative management; however, intraperitoneal drains frequently migrate. We evaluated whether extraperitoneal tunneling (EPT) of the pelvic drain reduces drain displacement compared with conventional intraperitoneal placement.
Methods This single-center before-and-after comparative study enrolled adults with rectal cancer located within 15 cm of the anal verge who underwent elective radical resection between August 2021 and July 2024. Patients operated between August 2021 and December 2022 received conventional intraperitoneal drains (non-EPT group) and those operated between January 2023 and July 2024 received EPT drains (EPT group). The primary outcome was drain displacement (>3 cm from the anastomotic staple line) on postoperative day 2 plain radiograph. Secondary outcomes were AL, EPT-related complications, and the need for additional intervention. Multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were performed.
Results Of 228 patients, 111 received EPT and 117 received conventional drains. Drain displacement occurred in 5 of 111 EPT patients (4.5%) versus 55 of 117 non-EPT patients (47.0%; P<0.001). After multivariate adjustment, EPT was an independent protective factor (adjusted odds ratio [OR], 0.05; 95% confidence interval [CI], 0.02–0.13; P<0.001). The protective association was robust across PSM (matched OR, 0.07; 95% CI, 0.02–0.18) and IPTW (OR, 0.05–0.06; both P<0.001). AL occurred in 6 patients (2.6%) without a significant between-group difference (EPT, 1.8% vs. non-EPT, 3.4%; Fisher exact, P=0.681). Operative time, overall complications, and EPT-related complications did not differ between groups.
Conclusion In this single-center before-and-after series, EPT was associated with a substantially lower rate of postoperative day 2 drain displacement after rectal cancer surgery.
Complete mesocolic excision and central vascular ligation with D3 lymphadenectomy are important surgical principles for improving oncological outcomes in colon cancer. The cranial-first approach is a colonic mobilization–first approach to radical right hemicolectomy, which has several advantages, including early feasibility assessment, safe dissection from surrounding organs, preestablished inferior margin of lymph node dissection, and revelation of the tangible anatomy of the tributaries of the gastrocolic trunk. This video demonstrates the cranial-first approach to radical right hemicolectomy in a 66-year-old man with locally advanced cecal cancer.