Colon cancer nodal metastases: Biologic significance and therapeutic considerations

The controversy surrounding the extent of lymphatic resection for colon carcinoma has spanned several generations of surgeons. At present, two schools of thought exist: (1) lymphadenectomy is important for staging and therapy, and (2) lymphadenectomy is predominately useful for staging and prognosis but has minimal influence on overall survival. In this article, we review colonic lymphatic anatomy and pathology, methods of lymphadenectomy, the results of extended and conservative lymphadenectomy, the patterns of failure following colectomy, the adjuvant therapy of regional nodal metastasis, the effect of colon cancer biology on nodal metastasis, and the implications of nodal metastasis on tumor immunology. After review of data, we conclude with a statement of our current philosophy and recommendations for regional lymph node resection in colon cancer.