Lymph Node Metastasis Patterns in Right-Sided Colon Cancers: Is Segmental Resection of These Tumors Oncologically Safe?

Park, In Ja; Choi, Gyu–Seog; Kang, Byung Mo; Lim, Kyoung Hoon; Jun, Soo Han

doi:10.1245/s10434-009-0368-x

Cited by 81 publications

(54 citation statements)

References 13 publications

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“…Extrapolating data from the literature would imply central lymph node metastases (i.e., stump nodes) at the level of the ileocolic artery in 5-11.1% and right colic artery in 1.6-7.6%, when arterial division is performed on the right hand side of the superior mesenteric vein [11]. The concept of complete mesocolic excision (CME) when performing right colectomy for cancer has been introduced as a parallel to total mesorectal excision (TME) in rectum cancer surgery [8].…”

Section: Discussionmentioning

confidence: 99%

3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography

et al. 2010

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Section: Discussionmentioning

confidence: 99%

3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography

et al. 2010

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“…In our series, the ileocolic artery passed posterior to the superior mesocolic vein in 69% of cases but surprisingly did not result in a longer stump length probably because the superior mesocolic vein was never exposed. This is a potential issue as the area behind the vein is considered to a part of the mesocolon [24] and it is possible to find lymph node metastases in that area [25]. This emphases the fact, that the SMA should be divided at its origin no matter how it crosses the vein.…”

Section: Discussionmentioning

confidence: 99%

“…Only a small number of additional lymph nodes can be found at the high tie. However, there is a 10 % risk of D3 metastases hence it is worth considering the removal of these nodes [25,30]. If central tie is not performed, these nodes will be left behind and may give rise to tumour recurrence.…”

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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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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“…The variability in anatomical site of the first metastatic LN was highlighted by Tan et al, 27 who found that in 48% of cases the first metastatic LN was not adjacent to the tumour or was 5 cm beyond the longitudinal tumour margin in 18% of cases. Further, Park et al 28 reported that in 6% of caecal cancers LN metastases occurred along the right branch of the middle colic artery, which might not be included in a standard D2 segmental resection.…”

Section: Sentinel Lymph Node Mappingmentioning

confidence: 99%

Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease

et al. 2016

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Background5-aminolevulinic acid (5-ALA) is used for fluorescence diagnosis (FD) in neurological, gynaecological and urological malignancies. The Medical Research Council/Efficacy and Mechanism Evaluation (EME) programme/National Institute for Health Research’s Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten) study investigated its use to predict lymph node (LN)-positive disease in colon cancer as an aid to stratified surgery.ObjectivesThe primary objective was to optimise the dose of oral 5-ALA for intraoperative FD of metastatic LNs in colon cancer. Secondary objectives included standardisation of pre-operative computerised tomography (CT) LN reporting, intraoperative fluorescence detection, surgical resection with D3 lymphadenectomy and histopathological examination of resected specimens.DesignThis was a feasibility study to determine optimal strategies for 5-ALA positive LN detection. Patients with locally advanced disease identified using the Fluoropyrimidine, Oxaliplatin and Targeted-Receptor pre-Operative Therapy for patients with high-risk, operable colon cancer (FOxTROT) criteria were recruited from two sites between October 2013 and June 2015. Cohort 1 received 20 mg/kg and cohort 2 received 30 mg/kg of oral 5-ALA, 1–6 hours preoperatively. Laparoscopic assessment of fluorescence was performed using the Storz D-Light system (KARL STORZ GmbH & Co. KG; Tuttlingen, Germany), with marking of fluorescent LNs, followed by oncological resection. The specimen was subjected to histological analysis with step sectioning of marked fluorescent LNs. Progression to an evaluation phase using the optimal dosing schedule was dependent on positively identifying at least 2 out of 10 patients with metastatic LN disease in either cohort.ResultsA total of 44 patients were recruited with a male to female ratio of 26 : 18 and a mean age of 71 years (range 52–88 years). Cohort 1 consisted of 18 patients, of whom six had fluorescent primary cancers and three of these had fluorescent LNs. One out of 10 patients with metastatic LN disease had a fluorescent involved LN. Cohort 2 consisted of 26 patients, of whom eight had fluorescent primary cancers and four of these had fluorescent LNs. None of the fluorescent LNs contained disease in this cohort. No serious adverse events (SAEs) occurred but two mild, self-limiting, photosensitivity reactions were observed in cohort 2. The sensitivity and specificity for 5-ALA detection of LN-positive disease were: cohort 1 11.1%, 75%; and cohort 2 0%, 75%.LimitationsThis was a feasibility study exploring the use of 5-ALA for LN disease in a select cohort of patients with advanced colorectal cancer. The study population was small and generalisation to other cancers is not possible. The study was limited by the ability to determine LN-positive patients on the basis of pre-operative CT staging, which is often inaccurate, resulting in our cohorts containing several patients without LN disease.Conclusions5-ALA fluorescent diagnosis has poor sensitivity for discriminating LN-positive colon cancer. Its use as an aid to stratified colon cancer surgery is not supported. No SAEs were observed, suggesting that photosensitisers may be useful for intraoperative FD.Future work5-ALA has poor sensitivity for detecting LN metastases and cannot be recommended for intraoperative staging. Other, more sensitive fluorescent probes are required if this strategy is to be used.Study registrationCurrent Controlled Trials ISRCTN79949827 and EudraCT number 2012–002623–15.Funding detailsThis project was funded by the EME programme, a Medical Research Council and National Institute for Health Research partnership.

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Lymph Node Metastasis Patterns in Right-Sided Colon Cancers: Is Segmental Resection of These Tumors Oncologically Safe?

Abstract: Metastasis to lymph nodes along the right colic artery occurred in approximately 10% of the patients with transverse cancer, indicating the need for great care in deciding the extent of segmental resection for these patients.

Cited by 81 publications

References 13 publications

3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography

3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography

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

Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease

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