Incidence of and Risk Factors for Gastroepiploic Lymph Node Involvement in Patients with Cancer of the Transverse Colon Including the Hepatic Flexure

Abstract

Background To define the incidence of gastroepiploic lymph node (GLN) metastasis in patients with cancer of the transverse colon, including the hepatic flexure, and to identify the preoperative predictors of GLN involvement in a large‐volume center in China. Methods This retrospective monocentric cross‐sectional study respected the STROBE statement. Of 3208 consecutive patients who underwent colon cancer resection, a total of 371 patients with cancer of the transverse colon including the hepatic flexure who underwent complete mesocolic excision and GLN resection in our center were retrospectively reviewed between November 2010 and November 2017. Logistic regression was performed to identify predictors of GLN metastasis. Endoscopic obstruction was defined as a luminal obstruction of the colon severe enough to prevent the colonoscope from passing beyond the tumor regardless of the presenting symptoms. Results The GLN involvement rate was 4.0 (2.0–6.1)%. Patients who had GLN involvement had a significantly higher rate of endoscopic obstruction (P = 0.030), higher rate of signet ring adenocarcinoma or lymphovascular invasion (P < 0.05), higher preoperative CEA level (P = 0.037), more advanced pN stage (P < 0.001) and more advanced M stage (P = 0.003) than the patients without GLN involvement. ROC curve analyses showed that the cutoff value for CEA was 17.0 ng/ml (46.7% sensitivity, 84.3% specificity, P = 0.037) for the prediction of GLN metastasis. Multivariate analysis showed that endoscopic obstruction, signet ring adenocarcinoma, a CEA level ≥17 ng/ml and M1 stage were independently correlated with the GLN metastasis. Conclusion The incidence rate of GLN metastasis was low. To the best of our knowledge, the present study was the first to evaluate the preoperative predictors of GLN metastasis. Combinations of predictive factors may be useful for stratifying patients at high risk of GLN metastasis.

Extended Lymphadenectomy for Proximal Transverse Colon Cancer: Is There a Place for Standardization?

“…In cases with advanced colorectal tumors, it was clearly proven that excision of as many LN as possible is important at least for estimating survival and determining the indication for adjuvant cancer treatment [ 12 ]. In patients with colorectal cancer, successful resection of metastatic foci, such as those located in the lung or liver, is associated with significant long-term survival [ 13 ], and, as a consequence, the resection of non-regional LN metastases in high risk patients [ 14 ] should be associated with an OS benefit. This is particularly significant in our country, as most colorectal tumors are still diagnosed in advanced stages, leading to a death count of 34/100,000 (recorded in 2016–2018), almost twofold higher than the average European range [ 15 ].…”

“…In this sense, GCLN metastasis was identified as an independent prognostic factor for patients with TCC [ 25 ]. The question that rises is whether all patients with TCC should have an extended lymphadenectomy, or the identification of preoperative risk factors of GCLN involvement could guide indication for extended lymphadenectomy [ 9 , 14 , 24 ]. From the oncologist’s point of view, a completely resected TNM stage IV benefits from the same adjuvant chemotherapy as a locally advanced TNM stage III, which is up to 6 months of perioperative treatment [ 26 ].…”

Development and validation of a new stage-specific nomogram model for predicting cancer-specific survival in patients in different stages of colon cancer: A SEER population-based study and external validation

“…identified the small blood and lymphatic vessels connecting the transverse colon and the greater omentum and connecting the transverse colon and the pancreas, which may be the potential pathways for lymphatic metastasis to infrapyloric and gastroepiploic lymph nodes (IGLN) ( 33 ). Previous studies reported 0.7-22% incidence rates of IGLN metastases for right-sided colon cancer ( 34 – 42 ). In addition, the rates of IGLN metastases were higher (1.7-33%) in patients with positive mesocolic nodes ( 32 ).…”

Laparoscopic complete mesocolic excision with extended D3 lymphadenectomy for advanced hepatic flexure cancer: Addressing infrapyloric node dissection – A video vignette

“…There is no recommendation in current guidelines about IGLN routine dissection for hepatic flexure/transverse colon tumours. Few authors have reported IGLN metastases rates from colonic tumours (range 0.7%-22.0%) [4][5][6][7][8][9][10][11]. Routine IGLN dissection could increase morbidity and mortality [5].…”