**3. Lymphatic drainage**

Colic frame lymph nodes are present according to the Japanese Society for Cancer of the Colon and Rectum (JSCCR) in four areas:


Thus, segmental, limited, or extensive resections for transverse colon cancers follow Hohenberger's recommendations for mesocolon excision and central vascular ligation [19, 20].

There are several comparative studies between D2 or D3 lymphadenectomy recommendations for locally advanced cancers, that often present themselves in the emergency department. They do not show a clear advantage of D3 over D2 but recommend performing D3 lymphadenectomy to obtain a radial resection margin and a larger number of lymph nodes necessary for accurate staging [21–23]. The minimum number of lymph nodes required for an accurate staging is 12 [2, 24, 25].

Transverse colon cancer frequently metastasizes to the lymph nodes of the infrapyloric lymph nodes, pancreatic cephalic nodules, and gastro-colic ligaments [26].

Another aspect used in surgical resections of transverse colon cancers is resection of the hepatic or splenic flexures. It is, therefore, necessary to define this flexure, anatomically. There is no general surgical concept but the most common limit is represented by a portion of 10 cm belonging to the ascending or descending colon, respectively 1/3 corresponding to the transverse colon. The splenic flexure is always located higher, and more angled, often creating an additional obstacle [14].
