Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Eur J Surg Oncol. 2022 Apr;48(4):718-726. doi: 10.1016/j.ejso.2021.12.005. Epub 2021 Dec 4.
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.
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.
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.
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.
肝曲和横结肠具有复杂的交织淋巴血管解剖结构，横跨系膜和胃系膜之间。很少有研究调查肝曲和横结肠癌肿瘤的幽门下和胃网膜淋巴结（IGLN）转移的肿瘤学相关性。本研究旨在评估 IGLN 转移的发生率和危险因素，以及扩大淋巴结清扫术的适应证、手术并发症和肿瘤学结果。
根据 PRISMA 声明，对 PubMed、Embase 和 Cochrane 数据库进行了关于结肠癌 IGLN 淋巴结清扫的系统综述。根据 Joanna Briggs 研究所工具对研究进行了批判性评估。
共纳入 9 项研究。IGLN 转移的发生率为 0.7-22%。有转移性肠系膜淋巴结的患者中，IGLN 阳性率为 1.7-33.3%。术后并发症发生率为 8.5-36.9%，根据 Clavien-Dindo 分级大多为低级别。30 天内的术后死亡率为 0-5.4%。IGLN 转移与晚期疾病相关，5 年无进展生存率高达 33.9%。有两位作者报告了神经周围侵犯和 N 分期是危险因素，而另一位作者报告了内镜梗阻、印戒细胞癌、CEA 水平≥17ng/ml 和 M1 期是 IGLN 受累的危险因素。除了一项研究外，所有其他研究的质量均为中等/较高。
转移性 IGLN 并不少见，应高度考虑。IGLN 转移可能与侵袭性疾病相关。IGLN 清扫术与标准 CME 相比，不会增加发病率和死亡率。IGLN 受累的术前危险因素可以指导扩大淋巴结清扫术的手术适应证。
