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

BACKGROUND: Transverse colon cancers show behavioral differences in terms of the involvement of extramesocolic lymph nodes since they are closely related to all three embryological planes. These tumors have also been observed in the gastroepiploic-omental (GEOM) region, outside their usual regional areas. We will evaluate this new metastatic route in our own cases. METHODS: Thirty-four patients (16 female, 18 male) that presented to our clinic with hepatic flexure, transverse colon, and splenic flexure cancer between October 2011 and May 2017 were included in the study. Type of surgery, histopathology, and factors causing metastasis, morbidity, and mortality were evaluated. RESULTS: Cancer was located in the transverse colon in 20 patients (58.8%), hepatic flexure in 10 (29.4%), and splenic flexure in four (11.7%). Lymph node positivity in the GEOM region was present in four patients: in the infrapyloric region and pancreatic head, close to the hepatic flexure in three patients; and the midline of GEOM, close to the inferior body of the pancreas in one patient. Perineural invasion (p < .05) and N stage (p < .05) were associated with GEOM region metastasis. Tumor localization and age significantly increased pleural effusion. CONCLUSIONS: In transverse colon and both flexural tumors, we recommend planning the surgery according to the localization of the tumor and including the GEOM, infrapyloric and infrapancreatic areas. It is possible to discuss whether to perform extended excision for all or only selected patients. The best approach seems to be to evaluate the co-factors to manage these patients.

Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned.

PURPOSE: We aimed to identify prognostic factors affecting clinical outcomes in emergent primary resection. METHODS: A retrospective analysis of prospectively acquired data of 230 consecutive emergent patients between August 1994 and January 2005 were evaluated in this study. Sixty-nine patients applied with right colon obstruction and 161 patients with left. Resection and primary anastomosis was carried out in 128 patients and resection and stoma in 102 patients. The patients were divided into two cohorts: patients who developed poor outcome within 30 days after surgery and those who did not. RESULTS: Major morbidity or mortality were reported in 60 (26.1%) patients. Analysis revealed that the most important prognostic factors for poor outcome were American Anesthesiology Association (ASA) grade ≥3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥11, age >60 years, presence of peritonitis, and surgery during on-call hours. Age >60 years and on-call surgery were determinant factors in right-sided obstructions, whereas ASA grade ≥3, APACHE II score ≥11, and presence of peritonitis were determinant factors in left-sided obstructions. CONCLUSIONS: All these factors but the timing of the operation emphasize the pivotal role of the patient's physiological condition on admission. Accurate preoperative evaluation might predict the clinical outcome and help in establishing the most appropriate treatment.

Emergent resection for acute sigmoid volvulus: results of 106 consecutive cases.

INTRODUCTION: After nonoperative decompression of acute sigmoid volvulus, definitive surgery is necessary because of the high risk of recurrence. However, the optimal surgical technique for this purpose has not been determined. METHODS: We studied 106 consecutive patients (mean age, 60.9 (range, 26-93) years) who underwent emergency resection for acute sigmoid volvulus between 1992 and 2000. No patient underwent preoperative decompression techniques, had the bowel prepared, or received on-table lavage. RESULTS: Depending on the patient's condition and the surgeon's preference, either primary anastomosis (57 cases) or Hartmann's procedure (49 cases) was performed. The overall mortality rate was 6.6 percent (7/106). The presence of a gangrenous bowel increased the mortality rate to 11 percent. Wound infections were documented in 8 and 12 cases, intra-abdominal abscess occurred in 1 and 7 cases, and subsequent surgery was required in 6 and 5 patients who underwent primary anastomosis and Hartmann's procedure, respectively. There were four cases of anastomotic dehiscence (7 percent) and two cases of stoma revisions (4 percent). The median length of stay was eight days for both those who underwent primary anastomosis (range, 3-27 days) and those who underwent Hartmann's procedure (range, 5-29 days). CONCLUSION: Emergent primary resection of the acute sigmoid volvulus with or without anastomosis is adequate treatment for this emergent surgical problem.