The role of the lymph nodes in colon cancer

Metastatic spread of colon cancer to intermediate lymphnodes is found, depe nding on tumor stage, in up to 44 % of patients and to central lymph nodes in about 10 %. The incidence of skip metastases is estimated not to exceed 5 %. Tumorous involvement of pericolic lymph nodes occurs almost only withi n a 10 cm distance from the primary. There is only one prospective randomiz ed controlled trial available comparing hemicolectomy versus radical segmen tal colectomy in patients with left colonic cancer. In this limited study t here was no statistical difference regarding survival, mortality and morbid ity between the two groups. However, several large retrospective studies ar e in favor of extended colon resection with radical clearance of lymphatic tissue. In 198 patients with colon cancer excluding rectal cancer in a 6-ye ar period we performed 151 radical (76 %) and 47 segmental (24 %) colonic r esections. The median length of the specimens in an unstretched and formali n-fixed state was 39 cm and 19 cm, respectively. The mean number of investi gated lymph nodes was 16 and 22, respectively. 40% of our patients showed l ymph node metastases. In-hospital mortality was 4/198 patients (2 %) and su rgical morbidity occurred in 29/198 patients (15 %). We recommend radical c olonic resections in all potentially curable patients with colonic cancer.