Purpose <p>To date, no study has focused exclusively on D3 lymph node dissection for mid-transverse colon cancer. The present study compared surgical and oncological results following extended right hemicolectomy (exRHC) and transverse colectomy (TC) with standardized D3 lymphadenectomy in patients with locally advanced mid-transverse colon cancer.</p> Methods <p>Patients with stage II or III mid-transverse colon cancer who underwent D3 lymphadenectomy with central ligation of the middle colic artery (MCA) between January 2013 and December 2022 were divided into two groups by surgical procedure. We compared patient short- and long-term outcomes between the groups.</p> Results <p>Eighty-three patients (exRHC, <i>n</i> = 56; TC, <i>n</i> = 27) were analyzed. Overall complication rates (35.7% vs. 22.2%, <i>p</i> = 0.458) and Clavien-Dindo grade ≥ 3 complications (10.7% vs. 3.7%, <i>p</i> = 0.418) did not differ significantly between the exRHC and TC groups. In contrast, postoperative ileus occurred more frequently in the exRHC group (16.1% vs. 0%, <i>p</i> = 0.028), and the hospitalization duration was significantly longer in the exRHC group (8 vs. 7&#xa0;days, <i>p</i> = 0.016). The 3-year relapse free survival (RFS) was 86.3% for exRHC and 80.3% for TC (<i>p</i> = 0.63), and the 3-year overall survival (OS) was 92.6% and 91.6%, respectively (<i>p</i> = 0.778).</p> Conclusions <p>In advanced mid-transverse colon cancer with D3 lymph node dissection and central MCA ligation, exRHC associated with a higher risk of postoperative ileus and longer hospital stay than TC. Given similar oncologic outcomes, TC may be a more favorable surgical option owing to its faster recovery.</p>