Int J Colorectal Dis (2008) 23:669–673 Table 1 Clinical characteristics of patients Age (years) Sex (M:F) Body mass index (kg/m2) Operating time (min) Blood loss (ml) Time to pass flatus (days) Diet start (days) Hospital stay (days) TCC Transverse colon cancer, OSCC other site colon cancer, NS not significant a Values are ranges. Oncological quality by pathologic outcomes There were no statistical differences in the tumor size, proximal resection margin, distal resection margin, radial margin, and number of harvested lymph nodes between patients with TCC and OSCC (Table 2). Discussion Since laparoscopic colon resection was first reported in 1991 [1], laparoscopic surgery has been widely employed for various benign colorectal disease such as benign mass, diverticular disease, inflammatory bowel disease, rectal prolapse, and now increasingly for colorectal malignant disease. Evidences of the safety and efficacy of the laparoscopic surgery for colorectal cancer had been reported from several prospective randomized controlled studies and meta-analysis of several trials, which favored the laparoscopic surgery for colorectal cancer over conven- tional open surgery due to its many short-term benefits such as shorter hospital stay, reduced use of analgesics, and earlier recovery of bowel movements [2–6, 8–13]. Eventu- ally, long-term oncological safety of laparoscopic colon cancer resection was established, and the laparoscopic approach was accepted as an alternative to open surgery for colon cancer by the COST study [7]. Transverse colon cancer occurs in about 10% of cases of colorectal cancer, and it often presents a challenge for the choice of the best surgical procedure based on the location of the tumor and extent of lymph node dissection. There could Table 2 Pathological outcomes of patients Tumor size (cm) PRM (cm) DRM (cm) No. of lymph nodes Radial margin (cm) TCC (N=34) 64.1±11.3 15:19 23.5±3.0 211.1±52.2 (140–360)a 100.0±83.8 (0–400)a 2.8±0.8 4.2±1.8 11.4±4.1 OSCC (N=94) 62.5±12.1 46:48 24.0±3.1 220.4±94.3 (60–620)a 114.2±145.2 (0–700)a 2.6±1.0 4.2±2.8 11.2±6.0 also be technical difficulties with laparoscopic identification, ligation, and lymph node dissection around the middle colic vessels depending on the surgeon’s experience. Because of these reasons, transverse colon cancer was excluded from almost every prior prospective randomized trial. Therefore, there is continued debate over the validity of laparoscopic surgery for transverse colon cancer. The major controversy about laparoscopic surgery for transverse colon cancer lies on whether or not it is feasible to perform sufficient extent of lymph node dissection around the middle colic artery laparoscopically. As experiences of laparoscopic surgery are accumulating and surgical techniques and instruments are developing, we consider that the extent of laparoscopic lymph node dissection for transverse colon cancer is not less than the extent of conventional lymph node dissection for transverse colon cancer. Some of the difficulties with laparoscopic surgery for transverse colon cancer that need to be resolved include the following: First, precise localization of carcinoma of the transverse colon is important; this is because the extent of resection and lymph node dissection depends on the location of the tumor in the transverse colon. Diminished tactile guidance can make localization of the tumor in the transverse colon more difficult in small tumor. There are a number of methods used to localize the tumor. Preoperative barium enema is useful for localization of large and advanced tumor, but radiological localization is inconclusive and difficult in early cancer. In such cases, colonoscopic tattooing with Indian ink or placing endo- scopic clips is very effective. Using endoscopic clip at the time of preoperative colonoscopy and using fluoroscopy 671 P value NS NS NS NS NS NS NS NS P value NS NS NS NS NS TCC (N=34) 5.2±2.5 (0.7–11)a 19.5±10.2 (10.0–25.0)a 13.9±6.9 (6.0–25.0)a 24.4±11.7 (3–59)a 0.9±0.8 (0–3.0)a OSCC (N=94) 4.6±2.4 (0.1–14)a 15.3±11.0 (4.2–25.0)a 11.6±5.3 (3.0–32.0)a 21.1±8.4 (3–59)a 1.0±0.9 (0–3.5)a TCC Transverse colon cancer, OSCC other site colon cancer, DRM distal resection margin, PRM proximal resection margin, NS not significant a Values are ranges.