Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method

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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“…All the lymph nodes draining the tumour-area are located within the mesocolon, mainly along the large vessels as they run centrally [28,29].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…[5][6][7] The incidence of lateral cancer spread in patients with lower rectal cancer has been reported as 10% to 25%. 6,8 Further, occult metastases are present in approximately 4% of patients who, based on conventional histologic examination, are negative for lateral node involvement. 9 It may safely be said that there have never been any commonly accepted treatments for patients with such disease.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Determinants of Patients With Lateral Nodal Involvement by Rectal Cancer

Ueno¹,

Mochizuki²,

Hashiguchi³

et al. 2001

Annals of Surgery

112

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ObjectiveTo clarify the characteristics related to long-term survival in patients with lateral nodal involvement. Summary Background DataFew reports have addressed the prognostic determinants in patients with actual lateral nodal involvement, which are important in determining treatment. MethodsReview of a prospective colorectal database at a single institution for a 10-year period (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996) identified 53 patients with lateral nodal involvement. ResultsAll nine patients who underwent resection of synchronous distant metastases developed recurrence and died within 3 years. Of the 44 patients without distant metastases, 25 (57%) developed locoregional recurrence, and the overall 5-year survival rate was 32%. Multivariate analysis showed that age, total number of involved nodes (mesorectal and lateral), and circumferential surgical margin involvement had independently predicted postoperative survival. Patients with three or fewer nodes involved accounted for one third of lateral-positive patients, with a 5-year survival rate of 75%, whereas the 18 patients with four or more involved nodes had a 5-year survival rate of 4%. All eight patients with circumferential margin involvement died of carcinoma, and seven developed locoregional recurrences. Involvement of other pelvic organs had no effect on prognosis, nor were adverse prognostic outcomes noted by the region of lateral involvement.

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“…They also demonstrated that this is a safe and feasible technique with at least the same morbidity and mortality as the "so called" standard technique. The concept of CME with CVL consists of creating an intact specimen encompassing the primary neoplasia along with all the potential pathways of tumor spread through central ligation of the main artery at its origin [9,10]. CME with CVL consists of two main components: the preservation of intact fasciae of the mesocolon between which relevant lymph nodes are contained in association with ligation of the blood vessels that supply the tumor colon site at their origin: at the level of the superior mesenteric vein for right sided neoplasms and at the level of their origin in the inferior mesenteric artery for left sided neoplasm [11].…”

Section: The Concept Of Complete Mesocolic Excisionmentioning

confidence: 99%

Optimal Colonic Cancer Surgery- the Concept of Complete Mesocolic Excision

BacalbaÈa¹,

Lintoiu²,

Bălescu³

2016

J Neoplasm

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Although colorectal cancer is one of the most common malignancies worldwide, the colon cancer related mortality significantly decreased in the last decades due to the wide implementation of screening programs and due to a better therapeutic approach. Once Heald introduced the concept of total mesorectal excision and demonstrated its' benefits in terms of oncological outcomes, attention was focused on the possibility of implementation of a similar technique for patients with colon cancer. This is how the concept of complete mesocolic excision appeared. This is a literature review regarding the surgical technique and oncologic outcomes of complete mesocolic excision.

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Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method

Cited by 159 publications

References 12 publications

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

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

Prognostic Determinants of Patients With Lateral Nodal Involvement by Rectal Cancer

Optimal Colonic Cancer Surgery- the Concept of Complete Mesocolic Excision

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