Abstract
Background. Colon cancer has been assumed to spread sequentially through the regional lymphatic
bed, with skip metastases occurring in only 1% to 3% of cases. Molecular techniques
allow the detection of occult metastases, but to date have not been applied to assess
the pattern of regional lymphatic spread of colon cancer. Methods. Fifty-five tumors from 54 patients with colonic adenocarcinoma were studied. Lymph
node mapping was performed on fresh colonic specimens recording the position of each
node on an anatomical diagram. Half of each lymph node was submitted for routine histology
examination and half assayed for keratin 20 gene expression by reverse transcription-polymerase
chain reaction. Logistic regression was used to analyze the distribution of histologic
and occult metastases. Results. A total of 1084 lymph nodes were dissected (median, 19 nodes; range, 4-52). Sixty-four
lymph nodes from 20 tumors had histologically evident metastases and 76 lymph nodes
from 13 tumors had occult metastases. There was no difference in the distribution
of either histologic or occult metastases among paracolic, intermediate, and apical
node groups. Ten patients had evidence of anatomical skip lesions after lymph node
mapping and molecular analysis, only 1 of which was histologically detectable. Conclusions. This study demonstrates a higher incidence of skip metastases in colon cancer assessed
by molecular techniques than has previously been reported, challenging the concept
of sequential development of early lymph node metastases.(Surgery 2001;129:684-91.)
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Article info
Publication history
Accepted:
December 8,
2000
Footnotes
*Supported by grants from the Anderson Telford Charitable Trust and the Otago Medical Research Foundation and by the Royal Australasian College of Surgeons Richard Stewart Scholarship (A. E. M.) and the New Zealand Gastroenterological Society-Glaxo/Wellcome Research Fellowship (A. E. M.).
**Reprint requests: Dr Arend Merrie, Department of Surgery, Northshore Hospital, PO Box 503, Takapuna, Auckland, New Zealand.
★Surgery 2001;129:684-91
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
