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J.Jpn. Surg. Soc.. 121(3): 306-308, 2020

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1) Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
2) Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Jun Watanabe1), Yusuke Suwa1), Atsushi Ishibe2), Chikara Kunisaki1), Itaru Endo2)

In surgery for the treatment of transverse colon (TC) cancer, the lymph flow differs depending on the localization of the cancer. We report surgical procedures for laparoscopic lymph node dissection (LLND) in TC cancer from the viewpoint of lymph flow evaluation. 1) Right TC (hepatic flexure):The feeding artery is the right branch of the middle colonic artery (rtMCA), but the lymphatic flow sometimes runs along the left branch of the middle colonic artery (ltMCA). In this case, the incision line of the transverse mesocolon is set near the ltMCA, or extended right hemicolectomy is required. 2) Mid-TC:The feeding artery is the ltMCA. Normally, the lymph flow in mid-TC flows along the ltMCA and into the no. 223 lymph node. In D3 dissection, it is necessary to dissect the root of the MCA. 3) Left TC (splenic flexure):The feeding artery is the ltMCA or accessory MCA (accMCA). The lymph flow in the left TC is varied, but in the presence of the accMCA it often flows along the accMCA, so that the accMCA is important for LLND. LLND for the treatment of TC cancer is performed by considering cancer localization and lymph flow.

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