Lymph Node Metastases in the Gastrocolic Ligament in Patients With Colon Cancer

Bertelsen, Claus Anders; Bols, Birgitte; Ingeholm, Peter; Jansen, Jens Erik; Jepsen, Lars Vedel; Kristensen, Bent Bruun; Neuenschwander, Anders Ulrich; Gögenur, Ismail

doi:10.1097/dcr.0000000000000144

Cited by 45 publications

(44 citation statements)

References 21 publications

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“…Bertelsen et al [16] have quite recently published a paper in which 364 patients operated on by CME were compared with 1,031 patients operated by conventional surgery from 3 other hospitals in Denmark (TNM stages I-III). The data showed significantly better 4-year disease-free survival in the CME group than in the conventional group.…”

Section: Discussionmentioning

confidence: 99%

“…The gastrocolic ligament is divided 10 cm distally from the tumour towards the stomach wall and the tissue around the epiploic arcade is removed including the pre-pyloric lymph nodes. Several authors have shown that 4% of all patients with a tumour in this location have metastases in the gastrocolic or pre-pyloric nodes [15,16]. In the TNM stage III patients, 12% of the patients have metastasis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study

Storli

Eide

2016

Dig Surg

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Background/Aim: Laparoscopic complete mesocolic excision (CME) used in the treatment of transverse colon cancer has been questioned on the basis of the technical challenges. The aim of this study was to evaluate the medium- and long-term clinical and survival outcomes after laparoscopic and open CME for transverse colon cancer and to compare the 2 approaches. Methods: This study was a retrospective non-randomized study of patients with prospectively registered data on open and laparoscopic CME for transverse colon cancer tumour-node-metastasis stages I-III operated on between 2007 and 2014. This was a single-centre study in a community teaching hospital. A total of 56 patients with transverse colon cancer were included, excluding those with tumours in the colonic flexures. The outcome aims were 4-year time to recurrence (TTR) and cancer-specific survival (CSS). Morbidity was also measured. Results: The 4-year TTR was 93.9% in the laparoscopic group and 91.3% in the open group (p = 0.71). The 4-year CSS was 97.0% in the laparoscopic group and 91.3% in the open group (p = 0.42). Limitations: This was a prospective single-institution study with a small sample size. Conclusion: Results of the study suggest that the laparoscopic CME approach might be the preferred approach for transverse colon cancer, especially regarding its benefits in terms of short-term morbidity, length of stay and oncological outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study

Storli

Eide

2016

Dig Surg

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“…CME in the present context has been defined previously 7 . The same definitions were applied to the control group, except for left hemicolectomies, which in the control group centres were often segmental resections (involving only the splenic flexure).…”

Section: Methodsmentioning

confidence: 99%

“…CME in this study is defined 5,6 as dissection in the mesocolic plane with central vessel ligation. The dissection is performed close to organs and vessels that are not usually fully exposed in 'conventional' colonic cancer surgery, and there is a risk of injury to, for example, the stomach or superior mesenteric vein (SMV) 7,8 . This has caused concern about possible higher mortality and morbidity related to CME compared with 'conventional' colonic cancer resection 3,9 .…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery

Bertelsen

Neuenschwander

Jansen

et al. 2016

British Journal of Surgery

178

134

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“…Exclusion criteria were: 1) patients with predicted T4 tumours on the preoperative CT scan as these patients often require more extensive surgery. 2) Tumours located in the transverse colon or at the flexures as these are few in number, the debate regarding the division of the arteries in this area is even more controversial [13,14], and the treatment of these cancers are organised differently in our region. …”

Section: Methodsmentioning

confidence: 99%

Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

et al. 2017

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There are no conflicts of interest Word count:Text: 2992 Abstract: 250Colon-CT study -3 - Abstract:Aim: Complete mesocolic excision for colon cancer includes central division of the tumour feeding artery. The degree of central radicality is assessed by measuring the distance from the tumour to the artery ligation by the pathologist on the resected specimen. As the length of the artery is highly variable between individuals, this technique may not be the most accurate measure of radicality as it cannot assess the length of the artery left behind inside the patient. The aim was to visualize the length of the tumour feeding artery after surgery and compare the relationship to pathological measures.Method: The length of the arterial stump was measured from the origin to the ligation point on a CT-scan two days post-operatively. This was done by a specialized radiologist who was blinded to operative procedure.Results: 52 patients had the required CT images. The mean length of the residual arterial stump was 38 mm, which was significantly longer than the expected length of <10 mm (p<0.0001). On the right side, the mean length was 31 mm and independent of the relation to the superior mesenteric vein. On the left side, the mean length was 49 mm. There was no correlation between the residual arterial stump and the pathological measures of specimen radicality.Conclusions: The residual arterial stumps measured by post-operative CT were longer than expected even on the right side where a CME was attempted.. Caution should be taken when using pathological measures as an estimation of a central ligation.Colon-CT study -4 -What does this paper add to the literature? This is the first study that measures the length of the remaining arterial stump after colon cancer surgery in a prospective and consecutive cohort. Furthermore, the results are compared to the pathological measures of central radicality on the specimen resected and we found no correlation.

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Lymph Node Metastases in the Gastrocolic Ligament in Patients With Colon Cancer

Cited by 45 publications

References 21 publications

Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study

Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study

Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery

Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

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