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Asian J Endosc Surg ISSN 1758-5902

ORIGINAL ARTICLE

Laparoscopic versus open resection for transverse and descending

colon cancer: Short-term and long-term outcomes of a multicenter
retrospective study of 1830 patients
Shigeki Yamaguchi,6 Jo Tashiro,6 Ryuichiro Araki,7 Junji Okuda,1 Tsunekazu Hanai,2 Koki Otsuka,3 Shuji Saito,4,9
Masahiko Watanabe5 & Kenichi Sugihara8
1 Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
2 Department of Colorectal Surgery, Fujita Health University, Toyoake, Japan
3 Department of Surgery, Iwate Medical University, Morioka, Japan
4 Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
5 Department of Surgery, Kitasato University Hospital, Sagamihara, Japan
6 Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
7 Community Health Science Center, Saitama Medical University, Moroyama, Japan
8 Department of Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
9 Department of Surgery, Yokohama Shin-Midori General Hospital, Yokohama, Japan

Keywords:
Descending colon cancer; laparoscopic
surgery; transverse colon cancer
Correspondence
Shigeki Yamaguchi, Department of
Gastroenterological Surgery, Saitama
Medical University International Medical
Center, 1397-1 Yamane, Hidaka, Saitama
350-1298, Japan.
Tel: +81 42 984 4111
Fax: +81 42 984 4741
Email s_yama@saitama-med.ac.jp
Received 7 January 2017; accepted 13
February 2017
DOI: 10.1111/ases.12373
Abstract
Introduction: Previous randomized controlled trials demonstrated similar
oncological outcomes between laparoscopic and open colectomies, except for
cases involving transverse colon and splenic flexure colon cancer. The objective
of this study was to confirm the oncological safety and advantages of the
short-term results of laparoscopic surgery for transverse and descending colon
cancer in comparison with open surgery.
Methods: The study data were retrospectively collected from the databases of 45
hospitals. Patients with transverse or descending colon cancer who underwent
laparoscopic or open R0 resection were registered. The primary end-points were
the 3-year overall survival and relapse-free survival rates according to
pathological stage. The secondary end-points were the short-term results,
including blood loss, operative time, diet intake, hospital stay, and postoperative
complications.
Results: Of the 1830 eligible patients, 872 underwent open colectomy and 958
underwent laparoscopic colectomy. The median follow-up period was
38.4 months. The conversion rate to open resection was 4.5%. The 3-year overall
survival rate of the laparoscopic group was significantly higher than that of the
open group for stage I patients (96.2% vs 99.2%; P = 0.04); it was also higher
for stage II (94.0% vs 95.5%) and stage III (87.4% vs 90.2%) patients, but there
were no significant differences. The 3-year relapse-free survival rate of the
laparoscopic group was significantly higher than that of the open group for stage
I patients; there were no differences between the open and laparoscopic groups
among the stage II and III patients. In the multivariate analyses, laparoscopic
resection was a significant factor in relapse-free survival. Laparoscopic patients
had significantly lower blood loss and a significantly longer operative time than
the open groups. Also, postoperative hospital stay was significantly shorter and
postoperative morbidity was significantly lower in the laparoscopic group.
Conclusion: Although this retrospective study has limitations, we can conclude
that laparoscopic surgery for transverse and descending colon cancer is
oncologically safe and yields better short-term results than open surgery.

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© 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd
Lap vs open: trans. & desc. colon cancer
Introduction
Since the first prospective, randomized trial of laparoscopic
and open colon cancer resection (1), several randomized
controlled trials have demonstrated similar oncological
outcomes between the two and the superiority of short-
term results of laparoscopic resection (2–6). However, these
randomized controlled trials have excluded transverse
colon cancer and, to a lesser extent, splenic flexure colon
cancer because they are technically demanding and their
occurrence is relatively rare (6).
Laparoscopic colectomy for colon cancer has become a
standard procedure, so it is important to confirm the
oncological safety of laparoscopic transverse colon
resection. According to the Japanese Society for Cancer of
the Colon and Rectum guidelines (7), most surgeons
generally should attempt to dissect and remove the origin
of the feeding vessel as a regional lymphadenectomy for
T3 cancer. The Japan Society of Laparoscopic Colorectal
Surgery conducted a multicenter retrospective cohort study
to compare laparoscopic and open resections for transverse
and descending colon cancer. We report the oncological
outcomes and short-term results from this study.
Materials and Methods
Patients
Patients from 45 hospitals who underwent transverse and
descending colon cancer resections were registered. The
operation period was from 1 January 2006 to 31 December
31 2008. The inclusion criteria were adenocarcinoma of the
transverse colon or the descending colon and R0 curative
resection. The exclusion criteria were stage IV cancer with
distant metastatic disease, macroscopic residual cancer,
synchronous or metachronous colorectal cancer, other
combined malignancy, and hand-assisted laparoscopic
surgery. The location of the tumor was determined based
on the intraoperative findings.
This study was approved by the ethics committee of the
Japan Society for Cancer of the Colon and Rectum and
the institutional review board of each participating
hospital.
Procedures
Laparoscopic resection was performed by member surgeons
of the Japan Society of Laparoscopic Colorectal Surgery.
Under pneumoperitoneum, mobilization of the colon
was performed laparoscopically in all patients. Vascular
ligation was performed in accordance with the
lymphadenectomy for each patient. In some institutions,
the vessels were ligated directly from a small skin incision
via an open method. Finally, the specimen was removed,
and anastomosis was performed extracorporeally via
© 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd
S Yamaguchi et al.
a functional end-to-end anastomosis or hand-sewn
anastomosis. Conversion to open surgery was defined as
an unplanned skin incision for the control of intraoperative
complications, severe adhesion, or unexpected tumor
extension. Operative methods and pathological results
were recorded in accordance with the Japanese
Classification of Colon and Rectal Carcinoma, seventh
edition, and the TNM classification, sixth edition (8,9).
Generally, pathological stage III was an indication for
postoperative adjuvant chemotherapy. During this period,
fluorouracil and l-leucovorin infusion were the standard
chemotherapy, but oral fluorouracil was also favorable
depending on the decision of the attending physician.
End-points
The primary end-points were the 3-year overall survival
(OS) and relapse-free survival (RFS) rates according to
pathological stages. The secondary end-points were the
short-term results, blood loss, operative time, solid diet
intake start, postoperative hospital stay, and postoperative
complications.
Statistical analysis
The analyses were performed in accordance with the intent-
to-treat principle; therefore, conversion-to-open resection
patients were included in the laparoscopic group. Both the
OS and RFS rates were calculated using the Kaplan–Meier
method, and the log-rank test was used to compare the
differences. Cox’s proportional hazards model and
likelihood ratio test were used for the multivariate models.
The secondary end-points of short-term results, including
blood loss, operative time, solid diet intake start, and
postoperative hospital stay, were compared using the
double-sided Mann–Whitney test. The secondary
end-point of the postoperative complication rate was
compared using Fisher’s exact test and the Fisher–
Freeman–Halton test. P-values <0.05 were considered
Figure 1 CONSORT diagram of the study.
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S Yamaguchi et al. Lap vs open: trans. & desc. colon cancer

Table 1 Baseline comparison between open and laparoscopic procedure

Open (n = 872) Laparoscopic (n = 958) P-value

Demographics
Sex (n) 0.63
Male 505 566
Female 367 392
Median age, years (IQR) 70.0 (61.0–77.0) 68.5 (60.0–76.0) 0.03
Median BMI (IQR) 22.2 (20.1–24.6) 22.7 (20.7–24.9) 0.002
Previous laparotomy (n) 331 (38%) 271 (28%) <0.001
Gastrectomy 49 13
Cholecystectomy 34 24
Appendectomy 107 139
Bowel resection 49 12
Urinary tract 13 11
Gynecology 60 56
Others 19 16
Comorbidity (n) 524 (60%) 538 (56%) 0.10
Primary lesion (n) 0.34
Transverse colon 609 649
Descending colon 263 309
Operative background
Lymph node dissection (n) <0.001
D0/1 93 104
D2 376 514
D3 403 340
Median lymph node harvest, n (IQR) 16 (10–26) 13 (8–19) <0.001
Intraoperative complication (n) 21 (2.4%) 31 (3.2%) 0.32
Bleeding 14 16
Other organ injury 3 9
Anastomotic failure 2 5
Others 2 1
Conversion to open surgery (n) — 43 (4.5%)
Method of lymph node dissection (n)
Laparoscopic — 797
Mini-laparotomy — 139
Open after conversion — 22
Pathological background
Median tumor size, mm (IQR) 35 (20–52) 25 (15–40) <0.001
TNM stage (n) <0.001
0 9 (1%) 49 (5%)
I 157 (18%) 417 (43%)
II 433 (50%) 239 (25%)
III 274 (31%) 254 (27%)
Depth of invasion (n) <0.001
T0 9 49
T1 118 326
T2 61 158
T3 513 345
T4 172 91
Grade of histological differentiation (n) <0.001
Well 349 515
Moderately 409 380
Poorly 72 35
Mucinous 28 17

IQR, interquartile range.

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Lap vs open: trans. & desc. colon cancer
statistically significant. All statistical analyses were performed
by one author (R.A.) using SAS version 9.1.3 SP4 (SAS
Institute, Cary, USA) and SAS JMP 11.0.0 (SAS Institute).
Results
Patient characteristics
From March 2011 to March 2012, 1926 patients were
registered. Of these patients, 96 were excluded because of
stage IV cancer (n = 37), R1 or R2 resection (n = 3), or
incomplete data (n = 56). Among the 1830 patients who
were available for analysis, 872 patients underwent open
colectomy and 958 patients underwent laparoscopic
colectomy (Figure 1). The median follow-up period of all
analyzed patients was 38.4 months.
Table 2 Conversion to open surgery
Reason for conversion
Overall†
Severe adhesion
Advanced cancer status
Bleeding
Technical difficulty
Obesity
Disorientation
Others
†
Conversion rate: 43/958 (4.5%).
Figure 2 Overall survival rate according to stage.
© 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd
S Yamaguchi et al.
The two study groups were well balanced in terms of sex,
comorbidity, and primary cancer lesion; age, BMI, and
previous laparotomy were statistically different. D3 lymph
node dissection and lymph node harvests were significantly
more frequent in the open group (8). Intraoperative
complications were similar in both groups. Regarding the
TNM stage distribution, there were more patients with stage
I in the laparoscopic group and more patients with stage II in
the open group. The number of patients with stages 0 and III
was almost equivalent in both groups. The histological grade
of differentiation was also significantly different (Table 1).
The conversion rate of laparoscopic to open resection was
4.5% (Table 2). Severe adhesion was the most common
reason (n = 14), and advanced cancer status, such as
invasion to other organs, and bleeding were the secondary
reasons for conversion to open surgery.
Analysis of survival rates
n (%)
43 (100%)
The 3-year OS rate was statistically better in the
14 (33%) laparoscopic group than in the open group during the stage
7 (17%) difference comparison in both groups. According to TNM
7 (17%) stage, the OS of the laparoscopic group was better for stage
6 (14%) I (open 96.2% vs laparoscopic 99.2%, P = 0.04), and there
3 (7%) were no significant differences between the two groups
2 (3%)
for stage II (open 94.0% vs laparoscopic 95.5%, P = 0.37)
4 (9%)
and stage III (open 87.4% vs laparoscopic 90.2%, P = 0.25)
(Figure 2). The RFS rate was also similar to the OS rate
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S Yamaguchi et al. Lap vs open: trans. & desc. colon cancer

between the two groups. The 3-year RFS rate for stage I was
significantly better in the laparoscopic group (open 92.7% vs
laparoscopic 97.8%, P = 0.001). There were no statistically
significant differences in the 3-year RFS rate for stages II
and III (II: open 86.2% vs laparoscopic 89.4%, P = 0.21; III:
open 71.4% vs laparoscopic 77.5%, P = 0.13) (Figure 3).
A univariate analysis was performed regarding the OS.
The type of procedure (laparoscopic and open) (hazard
ratio [HR]: 0.52, 95% confidence interval [CI]: 0.35–
0.79, P = 0.002) and TNM stage (1 and 2: HR: 3.49, 95%
CI: 1.70–8.10, P < 0.001; 2 and 3: HR: 2.11, 95%CI: 1.38–
3.26, P < 0.001) were significantly different. Only the TNM
stage was a significant factor in the multivariate analysis
(Table 3). Regarding the RFS, the type of procedure (HR:
0.53, 95%CI: 0.41–0.69, P < 0.001) and TNM stage (1 and
2: HR: 3.81, 95%CI: 2.34–6.55, P < 0.001; 2 and 3: HR:
2.22, 95%CI: 1.69–2.95, P < 0.001) were significant factors
in the univariate analysis. In the multivariate analysis of
RFS, the type of procedure was also a significant factor (HR:
0.69, 95%CI: 0.53–0.91, P = 0.007) (Table 4).
Short-term results
Blood loss in the laparoscopic group was significantly lower
than that in the open group for the overall stage and stages I
to III. Operative time in the laparoscopic group was
significantly longer than that in the open group for the
overall stage and each stage. Both postoperative solid diet
intake start and postoperative hospital stay were shorter in
the laparoscopic group (Table 5). No postoperative mortality

Figure 3 Relapse-free survival rate according to stage.

Table 3 Overall survival analysis

Univariate Multivariate

Crude HR 95%CI P-value Adjusted HR 95%CI P-value

Sex (M/F) 1.13 0.76–1.71 0.56 — — —
Age (years) 1.01 1.00–1.03 0.07 — — —
Location (D/T) 1.05 0.68–1.58 0.84 — — —
Procedure (Lap/open) 0.52 0.35–0.79 0.002 0.67 0.43–1.01 0.06
TNM 6th (1/2) 3.49 1.70–8.10 <0.001 2.93 1.41–6.90 0.003
TNM 6th (2/3) 2.11 1.38–3.26 <0.001 2.09 1.37–3.24 <0.001

CI, confidence interval; D, descending colon; F, female; HR, hazard ratio; Lap, laparoscopic; M, male; T, transverse colon.

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Lap vs open: trans. & desc. colon cancer S Yamaguchi et al.

Table 4 Relapse-free survival analysis

Univariate Multivariate

Crude HR 95% CI P-value Adjusted HR 95%CI P-value

Sex (M/F) 0.97 0.75–1.26 0.82 — — —
Age (years) 1.00 0.99–1.01 0.51 — — —
Location (D/T) 1.30 0.99–1.69 0.06 — — —
Procedure (Lap/open) 0.53 0.41–0.69 <0.001 0.69 0.53–0.91 0.007
TNM 6th (1/2) 3.81 2.34–6.55 <0.001 3.28 1.99–5.69 <0.001
TNM 6th (2/3) 2.22 1.69–2.95 <0.001 2.24 1.70–2.97 <0.001

CI, confidence interval; D, descending colon; F, female; HR, hazard ratio; Lap, laparoscopic; M, male; T, transverse colon.

Table 5 Short-term results

Open (n = 872) Laparoscopic (n = 958) P-value

Median Quartile Median Quartile

Blood loss count (mL)
All stages 87 35–230 35 10–81 <0.001
Stage I 59 21–122 30 10–67 <0.001
Stage II 105 40–283 43 12–90 <0.001
Stage III 90 35–220 40 10–100 <0.001
Operative time (min)
All stages 167 135–210 209 170–253 <0.001
Stage I 154 124–195 195 160–240 <0.001
Stage II 170 136–218 220 183–266 <0.001
Stage III 175 138–214 220 180–260 <0.001
Postoperative solid diet intake start (day)
All stages 5 3–6 3 3–4 <0.001
Stage I 4 3–6 3 3–4 <0.001
Stage II 5 3–6 3 3–4 <0.001
Stage III 5 3–6 3 3–4 <0.001
Postoperative hospital stay (day)
All stages 12 9–17 10 8–13 <0.001
Stage I 11 8–15 10 8–12 <0.001
Stage II 12 10–18 10 8–14 <0.001
Stage III 12 10–18 10 8–13 <0.001

Stages were determined according to the TNM, sixth edition.

was observed in the laparoscopic group; three patients died

Table 6 Postoperative complications
in the open group. The postoperative morbidity rate was
significantly higher in the open group (open 25.2% vs Open Laparoscopic P-value
(n = 872) (n = 958)
laparoscopic 15.8%). With regards to the complications,
wound infection occurred less frequently in the laparoscopic Mortality (n) 3 (0.3%) 0 0.11
Morbidity (n) 220 (25.2%) 152 (15.8%) <0.001
group than in the open group (open 9.7% vs laparoscopic
Ileus 36 (4.1%) 25 (2.6%) 0.09
6.4%). There was no significant difference in ileus and
Anastomotic leakage 8 (0.9%) 10 (1.0%) 0.82
anastomotic leakage between the groups (Table 6). Intra-abdominal 6 (0.7%) 0 (0.2%) 0.01
abscess
Anastomotic 2 (0.2%) 5 (0.5%) 0.46
Discussion hemorrhage
This study was planned to ensure that laparoscopic Pancreatic fistula 2 (0.2%) 1 (0.1%) 0.61
Wound infection 85 (9.7%) 61 (6.4%) 0.009
resection for transverse and descending colon cancer was
Other 81 (9.3%) 48 (5.0%) <0.001
oncologically safe with good short-term results, as with

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S Yamaguchi et al.
other sites of colon cancer. Previous retrospective studies
have reported that laparoscopic transverse colectomy
showed better short-term results than open surgery with
acceptable oncologic outcomes (10–12). However, all these
studies were single-center analyses with relatively few
cases. Therefore, we conducted a multicenter retrospective
study to evaluate large numbers of patients.
The 3-year OS rate for all stages was statistically better in
the laparoscopic group because of staging bias. Because this
study was a retrospective cohort study, stage distribution
bias was expected in the operation period. As a result, the
distribution of stages 0–I was 19% in the open group and
48% in the laparoscopic group. The number of cases with
stage III was around 30% and comparable in both groups.
Therefore, we assessed each survival rate separately in
accordance with the TNM stage. The OS curves were similar
in each stage from stages I to III, and there were no
significant differences between stages II and III. The
laparoscopic group had a statistically better 3-year OS rate
for stage I, but the laparoscopic procedure was not a
statistically significant factor in the multivariate analysis of
OS. The OS rates of the laparoscopic and open resections
were considered almost equivalent from these results. The
3-year RFS rate for each stage had a similar relationship
with the OS rate and was statistically better in the
laparoscopic group for stage I; there was no significant
difference between stages II and III. Furthermore,
laparoscopic resection was a significant factor in the
univariate and multivariate analyses of RFS in this study.
Therefore, there were no OS and RFS rates indicating that
the laparoscopic group’s inferiority to the open group.
Most large randomized trials have suggested that
laparoscopic and open colectomies have no difference in
survival, even with regard to the TNM stage (4,6), although
the Barcelona trial resulted in a better survival rate after
laparoscopic colectomy for stage III patients (2). In this trial,
a significant difference was observed in stage I patients, and
it is unclear why the laparoscopic group showed better
results for stage I. However, there were many T1 patients
in the laparoscopic group; it is possible that the laparoscopic
group included more T1a patients than the open group.
Lacy et al. suggested that immunity and surgical stress
may reduce cancer recurrence after laparoscopic re
section (2). Further studies are necessary to assess this
favorable outcome, but at least an almost equivalent
survival rate is expected for laparoscopic resection from
this study.
The rate of conversion to open surgery was 4.5% in this
study, which is lower than the rates observed in the Clinical
Outcomes of Surgical Therapy trial (21%) and in the Colon
Cancer Laparoscopic or Open Resection trial (19%) (4,6).
After these trials, the surgical techniques and devices
improved. Furthermore, the BMI of the Japanese patients
Asian J Endosc Surg •• (2017) ••– ••
© 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd
Lap vs open: trans. & desc. colon cancer
in the present study was generally lower than that of
patients in Western countries. However, transverse
colectomy is still technically demanding and has been
reported as a significant risk factor for conversion to open
surgery (13). In this study, adhesion was the most frequent
reason for conversion to open surgery. Therefore, further
improvements are required for a safe and skillful
laparoscopic surgery.
In this study, all short-term results, except for the
operative time of each TNM stage, were more favorable in
the laparoscopic group than in the open group, especially
in comparison with those of prior study outcomes
(2,3,14). There was significantly less bleeding in the
laparoscopic group; however, blood loss in the open group
was small compared with previous results (3,6). Blood loss
is generally measured by the weight of the gauze and
suction volume in Japan. Therefore, previous results using
the estimated blood loss were different from the counted
blood loss in this study.
A longer operative time has always been an issue in
laparoscopic procedures. Recently, the operative time of
laparoscopic colectomy has been shortened, and the
learning curve for laparoscopic surgery has become faster.
Technical improvements and further education in
transverse colectomy are still important. D3 lymph node
dissection is particularly technically demanding (7). The
skeletonization and division of the middle colic vessels are
complicated techniques because of the diverse anatomy of
the vessels (15). Therefore, the relatively longer operative
time in this study may have been caused by the
lymphadenectomy used in the Japanese-style D3
dissection. Both postoperative solid diet intake start and
hospital stay were shorter in the laparoscopic group. The
fast recovery after laparoscopic surgery is one of its greatest
advantages, with other trials having shown similar results
(2–4,14).
Postoperative complications after laparoscopic surgery
occurred less frequently than or at a similar rate to those
reported in previous studies (2,4,6,14). In this study, the
overall morbidity rate and wound infection rate in the
laparoscopic group were significantly lower than in the
open group. A recent survey of over 27 000 patients
suggested similar results (16).
Several issues are noted in this study. Given that this
study had a retrospective cohort design and was not a
randomized trial, there were likely biases with regard to
several factors such as the hospital, surgeons, indication
for laparoscopic surgery, and operation date. Randomized
trials are the gold standard to establish clinical evidence.
However, the frequency of transverse and descending
colon cancer is relatively low. Therefore, a planned
randomized trial for transverse colectomy would take a
long time. A very large number of patients—more than
Lap vs open: trans. & desc. colon cancer
1900—were registered in this study. All participating
surgeons were on staff at teaching hospitals and were
members of the Japan Society of Laparoscopic Colorectal
Surgery. We believe that this study could serve as a
reference for future studies.
Despite these limitations, the results of this study of more
than 1800 patients demonstrate that laparoscopic surgery
for transverse and descending colon cancer is oncologically
safe and has better short-term outcomes than those in
previous trials on right and sigmoid colon cancer.
Acknowledgments
This trial was funded by the Japanese Society for Cancer of
the Colon and Rectum. The authors have no conflicts of
interest to declare in association with this study. Further,
we thank the members of the Japanese Society of
Laparoscopic Colorectal Surgery for supporting this trial.
References
1. Milsom JW, Böhm B, Hammerhofer KA et al. A prospective,
randomized trial comparing laparoscopic versus conventional
techniques in colorectal cancer surgery: A preliminary report.
J Am Coll Surg 1998; 187: 46–54.
2. Lacy AM, García-Valdecasas JC, Delgado S et al. Laparoscopy-
assisted colectomy versus open colectomy for treatment of
non-metastatic colon cancer: A randomised trial. Lancet 2002;
359: 2224–2229.
3. Leung KL, Kwok SP, Lam SC et al. Laparoscopic resection of
rectosigmoid carcinoma: Prospective randomised trial. Lancet
2004; 363: 1187–1192.
4. Clinical Outcomes of Surgical Therapy Study Group. A
comparison of laparoscopically assisted and open colectomy
for colon cancer. N Engl J Med 2004; 350: 2050–2059.
5. Jayne DG, Guillou PJ, Thorpe H et al. Randomized trial of
laparoscopic-assisted resection of colorectal carcinoma: 3-year
results of the UK MRC CLASICC trial group. J Clin Oncol
2007; 25: 3061–3068.
© 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd
S Yamaguchi et al.
6. The Colon Cancer Laparoscopic or Open Resection Study
Group. Survival after laparoscopic surgery versus open surgery
for colon cancer: Long-term outcome of a randomised clinical
trial. Lancet Oncol 2009; 10: 44–52.
7. Watanabe T, Itabashi M, Shimada Y et al. Japanese Society for
Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for
the treatment of colorectal cancer. Int J Clin Oncol 2012; 17: 1–29.
8. Japanese Society for Cancer of the Colon and Rectum. General
Rules for Clinical and Pathological Studies on Cancer of the Colon,
Rectum and Anus, 7th edn. Tokyo: Kanehara-Syuppan, 2006
(in Japanese).
9. Sobin LH & Wittekind C. TNM classification of malignant tumors,
6th edn. New York: Wiley-Liss, 2002.
10. Yamamoto M, Okuda J, Tanaka K et al. Clinical outcomes of
laparoscopic surgery for advanced transverse and descending
colon cancer: A single-center experience. Surg Endosc 2012;
26: 1566–1572.
11. Kim HJ, Lee IK, Lee YS et al. A comparative study on the
short-term clinicopathologic outcomes of laparoscopic surgery
versus conventional open surgery for transverse colon cancer.
Surg Endosc 2009; 23: 1812–1817.
12. Fernández-Cebrián JM, Gil Yonte P, Jimenez-Toscano M et al.
Laparoscopic colectomy for transverse colon carcinoma: A
surgical challenge but oncologically feasible. Colorectal Dis
2013; 15: 79–83.
13. Yamamoto M, Okuda J, Tanaka K et al. Effect of previous
abdominal surgery on outcomes following laparoscopic
colorectal surgery. Dis Colon Rectum 2013; 56: 336–342.
14. Guillou PJ, Quirke P, Thorpe H et al. Short-term endpoints
of conventional versus laparoscopic-assisted surgery in
patients with colorectal cancer (MRC CLASICC trial):
Multicentre, randomised controlled trial. Lancet 2005; 365:
1718–1726.
15. Yamaguchi S, Kuroyanagi H, Milsom JW et al. Venous
anatomy of the right colon: Precise structure of the major veins
and gastrocolic trunk in 58 cadavers. Dis Colon Rectum 2002; 45:
1337–1340.
16. Lawson EH, Hall BL, Ko CY Risk factors for superficial vs
deep/organ-space surgical site infections: Implications for
quality improvement initiatives. JAMA Surg 2013; 148:
849–858.
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