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Infrapyloric and gastroepiploic node dissection for hepatic flexure and transverse colon cancer: A systematic review

Authors
Piozzi, Guglielmo NiccoloRusli, Siti MayuhaBaek, Se-JinKwak, Jung-MyunKim, JinKim, Seon Hahn
Issue Date
Apr-2022
Publisher
W. B. Saunders Co., Ltd.
Keywords
Colon cancer; Infrapyloric nodes; Gastroepiploic nodes; Gastrocolic ligament; Transverse colon; Hepatic flexure
Citation
European Journal of Surgical Oncology, v.48, no.4, pp.718 - 726
Indexed
SCIE
SCOPUS
Journal Title
European Journal of Surgical Oncology
Volume
48
Number
4
Start Page
718
End Page
726
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/60914
DOI
10.1016/j.ejso.2021.12.005
ISSN
0748-7983
Abstract
Introduction The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated the oncological relevance of metastatic infrapyloric and gastroepiploic lymph nodes (IGLN) from hepatic flexure and transverse colon tumors. This study aimed to evaluate the incidence and risk factors for IGLN metastases, and the indications, surgical morbidities, and oncological outcome following extended lymphadenectomy. Materials and methods According to the PRISMA statement, a systematic review on IGLN lymphadenectomy for colon cancer was conducted into PubMed, Embase, and Cochrane databases. A critical appraisal of study was performed according to the Joanna Briggs Institute Tools. Results Nine studies were included. IGLN metastases incidence ranged 0.7–22%. IGLN positivity for patients with metastatic mesocolic lymph nodes ranged 1.7–33.3%. Postoperative complication rate ranged 8.5–36.9%, mostly low grade according to Clavien-Dindo's classification. Postoperative mortality rate ranged 0–5.4% at 30-days. IGLN metastases were associated with advanced disease with a 5-year progression-free survival rate up to 33.9%. Two authors reported perineural invasion and N stage as risk factors, while another reported endoscopic obstruction, signet ring adenocarcinoma, CEA level ≥17 ng/ml, and M1 stage to be risk factors for IGLN involvement. Apart from one study, all other studies were of moderate/high quality. Conclusions Metastatic IGLNs are not uncommon and should be highly considered. IGLN metastases could be potentially associated with an aggressive disease. IGLN dissection is not associated with higher morbidity and mortality than standard CME. Preoperative risk factors of IGLN involvement could guide surgical indication for extended lymphadenectomy.
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Anam Hospital (Department of Colon and Rectal Surgery, Anam Hospital)
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