Overview
Cancer and polyps in the middle of the colon.
The transverse colon is the segment that runs across the upper abdomen between the right colic flexure (under the liver) and the left colic flexure (under the spleen). Disease in this segment is uncommon — most colon cancers are right-sided or left-sided — but when a tumor or large polyp does sit in the middle, the right operation depends on exactly where the lesion is. A true transverse colectomy removes only the transverse segment and reconnects the right and left colon together. More often, we perform an extended right hemicolectomy for lesions on the hepatic flexure side, or an extended left hemicolectomy for lesions on the splenic flexure side, because that gives a more reliable blood supply at the anastomosis.
We perform the great majority of mid-colon resections minimally invasively — robotically or laparoscopically — through four to five small abdominal incisions. The omentum (the fatty apron that hangs from the transverse colon) is removed with the specimen for cancer cases, and the middle colic artery is divided at its origin from the superior mesenteric artery for proper lymph node clearance. The choice between a pure transverse colectomy and an extended hemicolectomy is made in the office before surgery based on the colonoscopy location and the staging CT scan.
Who is a candidate?
Patients with a transverse colon cancer, a large polyp not removable by colonoscopy, a flexure tumor, localized Crohn's disease of the mid-colon, or an obstructing mid-colon mass are candidates. We get a staging CT chest, abdomen, and pelvis with CEA before cancer surgery. The decision between a pure transverse colectomy and an extended hemicolectomy is largely based on the location relative to the flexures and the blood supply patterns we see on cross-sectional imaging.
How we perform it
Under general anesthesia, four to five small ports are placed in the abdomen. The omentum is taken with the specimen. We mobilize both colic flexures, identify the middle colic vessels, and divide them at their origin from the superior mesenteric artery. The transverse colon is divided proximally and distally in healthy tissue, and a stapled or sewn anastomosis is created between the right and left colon. For lesions closer to a flexure, we extend the resection to the right or left to put the anastomosis on a segment with stronger blood supply. Operations typically take 2.5–4 hours.
Recovery
Most patients stay 3–5 nights. You will walk the evening of surgery, sip clear liquids the next morning, and advance to a regular diet over the next day or two as bowel function returns. Stooling may be looser than baseline for a few weeks before the colon adapts. Desk work resumes at 2–3 weeks; lifting and full activity at 4–6 weeks. For cancer cases, the first surveillance visit is at 2 weeks with the operating surgeon and a longer-term plan with medical oncology starts shortly after.
Why Florida Surgical
Dr. Shaw is fellowship-trained in surgical oncology and performs robotic colon resections at high volume across our South Florida hospitals. Mid-colon resection is one of the operations where surgical judgment — choosing the right resection geometry rather than just doing a textbook segment — drives outcomes. We make that decision deliberately in the office before surgery and discuss the trade-offs with you directly.
Frequently asked questions
Why is a transverse colectomy uncommon?
The blood supply at the splenic flexure is the weakest in the colon, so an anastomosis there has a higher risk of leak. Most modern surgeons favor an extended right or extended left hemicolectomy instead, which moves the anastomosis to a segment with more reliable blood supply. A pure transverse colectomy is reserved for situations where the tumor sits truly in the middle and the blood supply on imaging looks robust.
Will I need a colostomy?
Almost never. The colon is reconnected during the same operation. A diverting stoma is only considered in rare emergencies — perforation, obstruction with contamination, or in a very high-risk patient.
How long is recovery?
Hospital stay is typically 3–5 days. Desk work resumes in 2–3 weeks; lifting and full activity in 4–6 weeks. Recovery from minimally invasive surgery is much faster than from open.
Will my bowels work normally after?
Most patients have looser, more frequent stools for a few weeks and then return to baseline. The remaining colon adapts and water reabsorption normalizes within the first couple of months.
Is robotic better than open?
For appropriate patients, robotic and laparoscopic resection give less pain, smaller scars, and faster recovery than open, with equivalent cancer outcomes. The middle colic vessel dissection and omentectomy are well-suited to a robotic approach.