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Lymph Node Mapping in Transverse Colon Cancer Treated Using Laparoscopic Colectomy With D3 Lymph Node Dissection.

Hironori Fukuoka1,2, Yosuke Fukunaga1, Toshiya Nagasaki1

  • 1Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

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Summary

Laparoscopic surgery for transverse colon cancer is feasible, with lymph node metastasis being the key predictor of recurrence-free survival. Lymph node mapping aids dissection in managing this cancer.

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Colorectal Cancer Research

Background:

  • Laparoscopic surgery for transverse colon cancer is understudied, with optimal procedures remaining controversial.
  • Existing randomized trials have excluded this procedure for various reasons, limiting evidence-based guidelines.

Purpose of the Study:

  • To analyze lymph node metastasis patterns in transverse colon cancer.
  • To evaluate short- and long-term outcomes of laparoscopic surgical procedures for transverse colon cancer.

Main Methods:

  • A single-center retrospective study involving 252 patients who underwent laparoscopic surgery for transverse colon cancer.
  • Transverse colon cancer was categorized by segment (right, middle, left), with surgical procedures tailored accordingly (right hemicolectomy, transverse colectomy, left hemicolectomy).
  • Postoperative lymph node mapping and pathological analysis were performed to assess metastasis patterns and vascular invasion.

Main Results:

  • Lymph node metastasis frequencies were 28.2% (right), 19.2% (middle), and 19.2% (left). Skipped metastasis occurred in right-sided and left-sided cancers but not middle-segment.
  • Pathological vascular invasion was significantly higher in right and left hemicolectomies compared to transverse colectomy.
  • Five-year survival rates were high across procedures (overall: 92.7-96.3%; relapse-free: 88.3-95.5%). Lymph node metastasis was the sole independent risk factor for relapse-free survival.

Conclusions:

  • Laparoscopic surgery is a feasible approach for transverse colon cancer.
  • D3 lymphadenectomy and harvested lymph node mapping can guide surgical dissection.
  • Node-positive cancer is the only independent prognostic factor for relapse-free survival in transverse colon cancer treated laparoscopically.