Mesocolic Lymph Node Number, Size, and Density

Ahmadi, Omid; McCall, John L.; Stringer, Mark D.

doi:10.1097/dcr.0000000000000413

Cited by 7 publications

(6 citation statements)

References 41 publications

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“…The average number of LNs in our results was 62.0 ± 22.3, similar to Ahmadi et al’s 24 study, which revealed 61 and 71 median LNs per cadaver in the ascending mesocolon and sigmoid, respectively. The research of Hida et al 25 showed that the mean number of nodes examined per patient was 76.4 after the clearing method was performed.…”

Section: Discussionsupporting

confidence: 91%

Lymph node harvesting after laparoscopic complete mesocolic excision colectomy in colon cancer with practical application of glacial acid, absolute ethanol, water, and formaldehyde solution: A prospective cohort study

Nguyen,

Dang,

Song Nguyen

et al. 2024

SAGE Open Medicine

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Objectives: Quality of surgery has recently become an essential topic in the prognosis of colon cancer. Complete mesocolic excision for colon cancer has recently gained popularity with high-quality surgery. Patient specimens after complete mesocolic excision with central vessel ligation procedures have an integrity of the mesocolon and the yield of three fields of lymph node harvest. We apply the glacial acid, absolute ethanol, water, and formaldehyde solution to each specimen based on the Japanese classification of lymph node groups and station numbers. We aim to identify the distribution and status of lymph node metastasis according to each tumor site and some pathological characteristics related to this disease. Methods: A prospective cohort study was performed on 45 laparoscopic complete mesocolic excision surgery patients. Results: 2791 lymph nodes were harvested after complete mesocolic excision surgery. The average number was 62.0 ± 22.3 nodes. The mean tumor size (in the largest dimension) was 4.2 ± 1.8 cm. The average length of the resected bowel segments was 29.1 ± 7.7 cm. There are 63 (2.3%) node metastases in 2791 lymph nodes, in which 17/45 (37.8%) patients had pN(+). The minimum positive node size was 1 mm. The positive pericolic lymph nodes (station 1) accounted for the highest rate, with 53 nodes (1.9%). The number of lymph nodes in young age ⩽60 is more significant than in older. The results were similar, with a more significant node retrieval in the group with a tumor size >4.5 cm and specimen length >25 cm. The number of lymph nodes in lower tumor invasive (pT1,3) was smaller than pT4. Our research shows that the cecum, ascending, and descending colon had greater nodes than others, with a mean number of 78.6, 74.2, and 71.3, respectively. Conclusions: The metastasis and harvested lymph nodes accounted for the highest rate of colon cancer in station 1 and the lowest rate in station 3. The number of retrieved lymph nodes was significantly associated with tumor location, size, specimen length, and patient age.

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Section: Discussionsupporting

confidence: 91%

Lymph node harvesting after laparoscopic complete mesocolic excision colectomy in colon cancer with practical application of glacial acid, absolute ethanol, water, and formaldehyde solution: A prospective cohort study

Nguyen,

Dang,

Song Nguyen

et al. 2024

SAGE Open Medicine

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“…According to existing research, age, tumor location, tumor size and T stage had been shown to affect LNM in colorectal cancer 17,29,30 Cancer risk communication in sensitivity and speci city for preoperative N stage remains di cult when compared to T stage because differentiating between malignant and reactive lymph node enlargement is di cult 34 . Therefore, studies have aimed at improving the detection rate for positive lymph nodes [35][36][37] .…”

Section: Discussionmentioning

confidence: 99%

Risk factors of central area lymph nodes metastasis for guiding optimal right colon cancer surgery: A retrospective multicenter study

Feng

Wang

Feng

et al. 2022

Preprint

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Background: D3 or CME lymphadenectomy for right colon cancer (RCC) with lymph nodes metastasis (LNM) is strongly recommended but the anatomical landmark remains controversial. Central LNM predicted poor prognosis in RCC and determined the extent of lymphadenectomy. Methods: Data for 1712 RCC patients treated with D3/CME lymphadenectomy were reviewed. These patients had been treated in 9 centers. A total of 1023 RCC patients were enrolled in the derivation cohort while 689 patients were enrolled in the validation cohort. Results: The overall central LNM incidence was 12.58% (215/1712). In the derivation cohort, univariate and multivariate cox regression analyses revealed that preoperative N staging based on CT scan (OR=7.85, 95% CI, 4.53-14.51, p<0.001), tumor differentiation (OR=0.53, 95% CI, 0.33-0.86, p=0.01) and intraoperative view of tumor movability (OR=0.53, 95% CI, 0.33-0.86, p=0.02) were significant independent factors. Areas under receiver-operating characteristic curves (AUC) for assessing central LNM in the derivation and validation cohorts were 0.802 and 0.750, respectively. The risk-scoring system for patients with RCC was also established. A score of 0 points was the optimal cut-off value for central LNM. Compared to patients in the low-risk group, patients in the high-risk group exhibited worse overall survival outcomes (p<0.001).Conclusions: The established model can be used for preoperative assessment of the risk of central LNM in RCC patients, and for determining the landmark for D3/CME lymphadenectomy, therefore might contribute to decreased therapeutic complications and improved clinical outcomes.

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“…Although more emphasis should be placed on lymph nodes yield, fatty replacement is one of the major obstacles. This di culty lied in the recognition of LNs in adipose tissue, and it had been reported that fatty in ltration was occurred in about 30% of LNs detected from specimen [4,34]. Another obstacle is that more than 90% of LNs in mesocolons were smaller than 5mm and almost 60% were less than 2mm in maximum length [4].…”

Section: Discussionmentioning

confidence: 99%

“…This di culty lied in the recognition of LNs in adipose tissue, and it had been reported that fatty in ltration was occurred in about 30% of LNs detected from specimen [4,34]. Another obstacle is that more than 90% of LNs in mesocolons were smaller than 5mm and almost 60% were less than 2mm in maximum length [4]. Furthermore, RCC has been considered to have higher lymph nodes yield because of the longer colon needed to be respected, a greater proportion of tumors with microsatellite instability, and better antitumor immune response [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

“…Since the concept of complete mesocolic excision (CME) was proposed in the last decade, it has been adopted to carry out more radical operations globally [1,2]. Regional LNs metastases are regarded as one of the most critical prognostic indicators for colorectal cancer (CRC), and the lymph node yield has been proved to be an independent risk factor in patients with CRC [3,4]. Therefore, the complete removal of the mesentery wrapped by visceral peritoneum and mesenteric fascia that contain the regional draining lymph nodes of the tumor area, become the main component of CME [5].…”

Section: Introductionmentioning

confidence: 99%

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Regional Lymph Nodes Distribution Pattern in Central Area of Right-sided Colon Cancer: In-Vivo Detection and the Update on the Clinical Exploration.

Feng

et al. 2020

Preprint

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BackgroundDistribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of a right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate.MethodsCarbon Nanoparticles (CNs) or Indocyanine Green (ICG) were used as dye and we laparoscopically observed the stained LNs distribution pattern and analyzed the harvested LNs combined with pathology report. Lastly, 137 RCC patients who received a “superior mesenteric artery (SMA)-oriented” hemicolectomy from September 2016 to September 2020 were included to calculate the probability of LNs metastasis in our target area.Results20 patients diagnosed as RCC (mean age 55.55 years, 13 male) were included. 13 patients underwent CNs injection and 7 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 17 cases (85%), posterior to SMV area in 6 cases (30%), and anterior to SMA in 11 cases (55%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (²= 5.38, p= 0.020). The probability of LNs metastasis in the above areas (target areas) was 2.19% (3/137). No dyed LNs occurred when the SMA sheath was exposed. What’s more, the number of total harvested LNs in patients with dye injection was significant more than dye-free RCC patients (22.44±13.78 vs 43.20±22.70, p<0.01). ConclusionRight-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of CME to place the internal border anterior to SMA and the removal of mesenteric tissue in our target area on lymphatic resection.

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Mesocolic Lymph Node Number, Size, and Density

Cited by 7 publications

References 41 publications

Lymph node harvesting after laparoscopic complete mesocolic excision colectomy in colon cancer with practical application of glacial acid, absolute ethanol, water, and formaldehyde solution: A prospective cohort study

Lymph node harvesting after laparoscopic complete mesocolic excision colectomy in colon cancer with practical application of glacial acid, absolute ethanol, water, and formaldehyde solution: A prospective cohort study

Risk factors of central area lymph nodes metastasis for guiding optimal right colon cancer surgery: A retrospective multicenter study

Regional Lymph Nodes Distribution Pattern in Central Area of Right-sided Colon Cancer: In-Vivo Detection and the Update on the Clinical Exploration.

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