Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study.

INTRODUCTION: Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS: This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS: The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS: According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.

[Stricture plasty in Crohn's disease. Indications and results]. / La stritturoplastica nel morbo di Crohn. Indicazioni e risultati.

BACKGROUND: Aim of the paper is to evaluate the indications and results of stricture plasty in the treatment of intestinal obstruction due to Crohn's disease. It is hypothesized that, as far as fibrotic strictures are treated, operative morbidity will be reduced to a minimum. METHODS: Data regarding 147 interventions for Crohn's disease performed in a 4.5 year-period have been prospectively collected. Eight interventions including stricture plasty have been identified and indication, morbidity and end results analyzed. RESULTS: In 8 interventions 20 stricture plasties have been performed. As a rule, a stricture plasty is performed only when a resection would have sacrificed a too long bowel tract or it was inappropriate, in relation to stricture site. Three patients had fistulae, but those fistulae were not in the same site of stricture plasty and only one patient was malnourished and with active disease. There was no operative mortality or major morbidity, but there was only a short episode of hyperthermia. No relapses were observed after a 26-month mean follow-up. CONCLUSIONS: Stricture plasty is a useful tool in order to avoid extensive intestinal resections. If it is performed only on fibrotic strictures with inactive disease and only if a resection is deemed inappropriate, minimal morbidity and very good results can be anticipated.