A 45-year-old man is diagnosed with stage II colorectal carcinoma located in the transverse colon. Which of the following is the surgical procedure of choice for this patient? A. Right hemicolectomy [5%] B. Transverse colectomy [36%] C. Extended right hemicolectomy [56%] D. Left hemicolectomy [3
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The answer is confirmed across multiple authoritative surgical textbooks. Here is the full explanation:
Answer: C. Extended Right Hemicolectomy
Why Extended Right Hemicolectomy?
For a carcinoma of the transverse colon, the operation of choice is an extended right hemicolectomy. This is supported by multiple major surgical textbooks:
Current Surgical Therapy (14th ed.) states directly:
"Tumors of the mid or distal transverse colon are managed with an extended right hemicolectomy, which involves ligation of the ileocolic, right colic, and middle colic pedicles and removal of the cecum, ascending colon, transverse colon, and construction with an ileodescending anastomosis."
Bailey and Love's Short Practice of Surgery (28th ed.) confirms:
"Carcinomas of the transverse colon and splenic flexure are most commonly treated by an extended right hemicolectomy."
Maingot's Abdominal Operations provides the standard resection table, showing:
| Tumor Location | Resection |
|---|---|
| Cecum | Right hemicolectomy |
| Ascending colon | Right hemicolectomy |
| Hepatic flexure | Extended right hemicolectomy |
| Transverse colon | Extended right hemicolectomy |
| Splenic flexure | Extended left hemicolectomy |
| Descending colon | Left hemicolectomy |
| Sigmoid colon | Rectosigmoid resection |
What the procedure involves:
- Resection extends from the terminal ileum to the descending colon (distal to the left flexure)
- Vessels ligated: Ileocolic artery + right colic artery + entire middle colic artery (this is the key distinction from a simple right hemicolectomy)
- Anastomosis: Ileodescending (ileum to descending colon)
- Adequate oncologic margins: 5 cm proximal and distal
- Minimum 12 lymph nodes must be harvested for accurate staging
Why not the other options?
| Option | Problem |
|---|---|
| A. Right hemicolectomy | Used for cecum, ascending colon, hepatic flexure - does NOT adequately clear the middle colic lymph node basin for transverse colon tumors |
| B. Transverse colectomy | A segmental resection is generally avoided because it is a "watershed" area with poor vascular supply, high anastomotic leak risk, and does not achieve adequate lymph node clearance |
| D. Left hemicolectomy | Used for descending colon and sigmoid cancers |
Key oncologic principle:
The transverse colon drains primarily via the middle colic vessels (a branch of the superior mesenteric artery). An extended right hemicolectomy allows high ligation of the entire middle colic pedicle at its origin, ensuring complete lymphadenectomy of the regional lymph node basin - something a simple transverse colectomy cannot reliably achieve.
Sources: Current Surgical Therapy 14e, p. 295; Bailey and Love's 28th ed., p. 1383; Maingot's Abdominal Operations, Table 36-14
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