Segmental transverse colectomy. Minimally invasive versus open approach: results from a multicenter collaborative study
Authors: Milone Marco , Degiuli Maurizio , Velotti Nunzio , Manigrasso Michele , Vertaldi Sara , D’Ugo Domenico , De Palma Giovanni Domenico ,   and Italian Society of Surgical Oncology Colorectal Cancer Network (SICO CCN) group, Allaix Marco Ettore , Ammirati Carlo Alberto , Anania Gabriele , Barberis Andrea , Belli Andrea , Bianco Francesco , Bianchi Paolo Pietro , Bombardini Cristina , Bruzzese Dario , Cavaliere Davide , Coco Claudio , Coratti Andrea , De Manzoni Giovanni , De Nardi Paola , De Simone Giuseppe , De Luca Raffaele , Delrio Paolo , Di Cataldo Antonio , Di Lauro Katia , Di Leo Alberto , Donini Annibale , Elmore Ugo , Fontana Andrea , Formisano Giampaolo , Gentilli Sergio , Giuliani Giuseppe , Graziosi Luigina , Guerrieri Mario , Li Destri Giovanni , Longhin Roberta , Mineccia Michela , Monni Manuela , Morino Mario , Ortenzi Monica , Pace Ugo , Pecchini Francesca , Pedrazzani Corrado , Piccoli Micaela , Pollesel Sara , Pucciarelli Salvatore , Reddavid Rossella , Rega Daniela , Rigamonti Marco , Rizzo Gianluca , Rosati Riccardo , Roviello Franco , Santarelli Mauro , Saraceno Federica , Scabini Stefano , Servillo Giuseppe , Sica Giuseppe Sigismondo , Sileri Pierpaolo , Simone Michele , Siragusa Luigi , Sofia Silvia , Solaini Leonardo , Tribuzi Angela , Turri Giulia , Vignali Andrea , Zuin Matteo , Zuolo Michele 
Published: September 2021

The role of minimally invasive surgery in the treatment of transverse colon cancer is still controversial. The aim of this study is to investigate the advantages of a totally laparoscopic technique comparing open versus laparoscopic/robotic approach. Three hundred and eighty-eight patients with transverse colon cancer, treated with a segmental colon resection, were retrospectively analyzed. Demographic data, tumor stage, operative time, intraoperative complications, number of harvested lymph nodes and recovery outcomes were recorded. Recurrences and death were also evaluated during the follow-up. No differences were found between conventional and minimally invasive surgery, both for oncological long-term outcomes (recurrence rate p = 0.28; mortality p = 0.62) and postoperative complications (overall rate p = 0.43; anemia p = 0.78; nausea p = 0.68; infections p = 0.91; bleeding p = 0.62; anastomotic leak p = 0.55; ileus p = 0.75). Nevertheless, recovery outcomes showed statistically significant differences in favor of minimally invasive surgery in terms of time to first flatus (p = 0.001), tolerance to solid diet (p = 0.017), time to first mobilization (p = 0.001) and hospital stay (p = 0.004). Compared with laparoscopic approach, robotic surgery showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.005) and tolerance to solid diet (p = 0.001). Finally, anastomosis evaluation confirmed the superiority of intracorporeal approach which showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.003) and tolerance to solid diet (p = 0.001); moreover, we recorded a statistical difference in favor of intracorporeal approach for infection rate (p = 0.04), bleeding (p = 0.001) and anastomotic leak (p = 0.03). Minimally invasive approach is safe and effective as the conventional open surgery, with comparable oncological results but not negligible advantages in terms of recovery outcomes. Moreover, we demonstrated that robotic approach may be considered a valid option and an intracorporeal anastomosis should always be preferred.