title: Surgical resection of locally advanced primary transverse colon cancer--not a worse outcome in stage II tumor.
abstract: OBJECTIVE
  In locally advanced primary transverse colon cancer, a tumor may cause perforation or invade adjacent organs. Extensive resection is the best choice of treatment, but such procedures must be weighed against the potential survival benefits. This study was performed to identify the clinicopathological features and treatment outcomes of such tumors.
  
  
  METHODS
  We retrospectively reviewed the database of the Colorectal Cancer Registry of Chang Gung Memorial Hospital between February 1995 and December 2005. Patients with colon cancer sited between the hepatic and splenic flexure that involved an adjacent organ without distant metastasis were defined as having locally advanced transverse colon cancer.
  
  
  RESULTS
  A total of 827 patients who underwent surgery for transverse primary colon cancer were enrolled in the study. Stage II and stage III colon cancer were diagnosed in 548 patients. Thirty-two (5.8%) patients were diagnosed with locally advanced tumors. Multivariate analysis revealed that stage III, preoperative carcinoembryonic antigen ≥5 ng/mL, a tumor with perforation or obstruction, and the presence of a locally advanced tumor were significant prognostic factors for both overall and cancer-specific survival. Postoperative morbidity rates differed significantly between the locally advanced and non-locally advanced tumor groups (22.7% vs. 12.3%, P < 0.01). No significant overall survival difference was observed among the stage II transverse colon tumors (P = 0.21).
  
  
  CONCLUSIONS
  Surgical resection of locally advanced transverse colon tumors resulted in a higher morbidity and mortality than that of non-locally advanced tumors, but the benefit of extensive surgery in the case of locally advanced tumors cannot be underestimated. Furthermore, this benefit is more pronounced in the case of stage II tumors.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing St., Kuei-Shan, Linko, Tao-Yuan, Taiwan.
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Hung
authors.forename: Chien-Yuh
authors.initials: CY
authors.lastname: Yeh
authors.forename: Chung-Rong
authors.initials: CR
authors.lastname: Changchien
authors.forename: Jinn-Shiun
authors.initials: JS
authors.lastname: Chen
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Fan
authors.forename: Reiping
authors.initials: R
authors.lastname: Tang
authors.forename: Pao-Shiu
authors.initials: PS
authors.lastname: Hsieh
authors.forename: Wen-Sy
authors.initials: WS
authors.lastname: Tasi
authors.forename: Yau-Tong
authors.initials: YT
authors.lastname: You
authors.forename: Jeng-Fu
authors.initials: JF
authors.lastname: You
authors.forename: Jeng-Yi
authors.initials: JY
authors.lastname: Wang
authors.forename: Jy-Ming
authors.initials: JM
authors.lastname: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D044684:Colon, Transverse / Q000473:pathology* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome