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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 10/2014

01-10-2014 | Original Article

Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations

Authors: Aristotelis Perrakis, Klaus Weber, Susanne Merkel, Klaus Matzel, Abbas Agaimy, Carol Gebbert, Werner Hohenberger

Published in: International Journal of Colorectal Disease | Issue 10/2014

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Abstract

Purpose

Complete mesocolic excision (CME) is nowadays state of the art in the treatment of colon cancer. In cases of carcinoma of transverse colon and of both flexures an extramesocolic lymph node metastasis can be found in the infrapancreatic lymph node region (ILR) and across the gastroepiploic arcade (GLR). These direct metastatic routes were not previously systematically considered. In order to validate our hypothesis of these direct metastatic pathways and to obtain evidence of our approach of including dissection of these areas as part of CME, we initiated a prospective study evaluating these lymph node regions during surgery.

Methods

Forty-five consecutive patients with primary tumour manifestation in transverse colon and both flexures between May 2010 and January 2013 were prospectively analyzed. Patients were followed up for at least 6 months. Mode of surgery, histopathology, morbidity and mortality were evaluated.

Results

Twenty-six patients had a carcinoma of transverse colon, 16 patients one of hepatic flexure and four patients one of splenic flexure. The median lymph node yield was 40. Occurrence of lymph node metastasis in ILR was registered in five patients and in GLR in four patients. The mean lymph node ratio was 0.085. Postoperative complications occurred in nine patients, and postoperative mortality was 2 %.

Conclusions

We were able to demonstrate this novel metastatic route of carcinomas of the transverse colon and of both flexures in ILR and GLR. These could be considered as regional lymph node regions and have to be included into surgery for cancer of the transverse colon including both flexures.
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Metadata
Title
Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations
Authors
Aristotelis Perrakis
Klaus Weber
Susanne Merkel
Klaus Matzel
Abbas Agaimy
Carol Gebbert
Werner Hohenberger
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 10/2014
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-014-1971-2

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