Bertelsen, Claus A1; Bols, Birgitte5; Ingeholm, Peter5; Jansen, Jens E1; Jepsen, Lars Vedel1; Kristensen, Bent6; Neuenschwander, Anders U1; Gögenur, Ismail7
1 Department of Gastroinstestinal Surgery, Nordsjællands Hospital, The Capital Region of Denmark2 Pathology, Herlev and Gentofte Hospital, The Capital Region of Denmark3 Department of Imaging and Radiology, Nordsjællands Hospital, The Capital Region of Denmark4 Gastroenterology, Herlev and Gentofte Hospital, The Capital Region of Denmark5 Patologisk Afdeling, Hillerød Hospital, Nordsjællands Hospital, The Capital Region of Denmark6 Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, The Capital Region of Denmark7 Urology, Herlev and Gentofte Hospital, The Capital Region of Denmark
BACKGROUND: Long-term survival after colorectal cancer may be improved by more extensive resection of the primary tumor and lymph nodes. Resection of the gastroepiploic and infrapyloric lymph nodes in the gastrocolic ligament has been proposed as a standard procedure when resecting tumors located in the proximity of the flexures or in the transverse colon. OBJECTIVE: The purpose of this work was to present our findings of metastases in the gastrocolic ligament in a consecutive series of patients. DESIGN: This was a single-center retrospective study. SETTINGS: The study was conducted in a colorectal cancer center. PATIENTS: All of the colon adenocarcinoma resections with relevant tumor location from June 1, 2008, to December 31, 2012 were included in this study. MAIN OUTCOME MEASURES: The presence of lymph node metastases in the gastrocolic ligament in colon adenocarcinomas located in the proximity of the flexures or in the transverse colon was measured. RESULTS: Gastrocolic resection was performed in 130 patients. Thirty-two patients were excluded because of a lack of information about gastrocolic lymph node status in the pathology reports. Median age of the remaining 98 patients was 70 years (range, 30-90 years), and 57% were men. Gastrocolic lymph nodes were found in 86 specimens (88%) with a median number of 4 lymph nodes (range, 0-16 lymph nodes). Thirty-four patients (35%) had mesocolic lymph node metastases. Gastrocolic lymph node metastases were found in 4 (12%) of these 34 patients and in 4% of all 98 included patients. Gastrocolic lymph node metastases were related to perineural invasion (p > 0.001). LIMITATIONS: Limitations of this study include the retrospective design, size of material, and lack of gastrocolic ligament lymph node status in the pathology report in some patients. CONCLUSIONS: Metastases in the gastroepiploic or infrapyloric lymph nodes can be found in patients with tumors located in the proximity of the flexures or in the transverse colon. Further studies are needed to reveal the clinical relevance of this finding, with special focus on recurrence risk and long-term survival.
Diseases of the Colon and Rectum, 2014, Vol 57, Issue 7, p. 839-45