Does transverse colon cancer spread to the extramesocolic lymph node stations?

Area of Science:

• Surgical Oncology
• Gastrointestinal Oncology
• Colorectal Cancer Research

Background:

• Transverse colon cancers exhibit unique metastatic behavior due to embryological origins.
• Unusual metastatic spread to the gastroepiploic-omental (GEOM) region has been observed.
• This study investigates GEOM region metastasis in transverse and flexural colon cancers.

Purpose of the Study:

• To evaluate the incidence and characteristics of metastasis to the GEOM region in patients with transverse and flexural colon cancers.
• To identify factors associated with GEOM region metastasis.
• To inform surgical planning for these specific tumor locations.

Main Methods:

• Retrospective analysis of 34 patients with hepatic flexure, transverse colon, or splenic flexure cancer (Oct 2011 - May 2017).
• Evaluation of surgical type, histopathology, metastasis patterns, morbidity, and mortality.
• Analysis of lymph node status, including the GEOM region.

Main Results:

• 20 cancers in the transverse colon (58.8%), 10 in the hepatic flexure (29.4%), and 4 in the splenic flexure (11.7%).
• Four patients (11.7%) showed lymph node positivity in the GEOM region.
• Perineural invasion and N stage were significantly associated with GEOM metastasis (p < .05).
• Tumor location and age correlated with increased pleural effusion.

Conclusions:

• Surgical planning for transverse and flexural colon tumors should incorporate the GEOM, infrapyloric, and infrapancreatic regions.
• Extended excision may be considered for selected patients based on co-factors.
• Tailoring surgical approach to tumor localization and patient-specific factors is recommended.