Optimal Ligation Level of the Primary Feeding Artery and Bowel Resection Margin in Colon Cancer Surgery: The Influence of the Site of the Primary Feeding Artery

Abstract

In T1 tumors, central node dissection is not required, but resection with proximal and distal 3-cm margins are required; in T2, central node dissection that includes the intermediate node should be performed in addition to resection with proximal and distal 5-cm margins. In T3 and T4, central node dissection that includes the main node should be performed in addition to resection with proximal and distal 7-cm margins. However, for T2 more than 5 cm from the primary feeding artery, and for T3 more than 7 cm from the primary feeding artery, proximal and distal resection alone may be adequate.

High Tie of the Inferior Mesenteric Artery in Curative Surgery for Left Colonic and Rectal Cancers: A Systematic Review

“…In the 144 patients who underwent a curative resection, the presence of metastases in the IMA root nodes was associated with a significantly lower 5-year survival rate (38.5 vs. 73.4%, p < 0.05). The same group[ 41] obtained similar results in 164 patients with colon cancer, of whom 104 had left colonic tumours. There were no metastases identified in the central node for pT1 or pT2 cancers, with lower survival rates for patients with involved main nodes as compared with those where only the intermediate nodes were involved (30.0 vs. 48.7%, p < 0.05).…”

Complete mesocolic excision and central vessel ligation for right colon cancers

“…A further body of predominant Japanese literature advocates radical lymph node dissections of varying magnitudes which may include remote nodal basins and those along major first order vessels such as the SMA [6]. Fundamental to these improved survival results is a standardized operative approach based on exploitation of embryological planes and careful sequential central vessel ligation ensuring an intact mesocolic envelope containing all potentially involved central lymph nodes.…”

Wide excision in right-sided colon cancer is associated with decreased survival

“…Although central ligation yields a larger number of examined lymph nodes (11,16,19,20), it has failed to prove increased survival (16,20). Furthermore, lateral spread more than 7-10 cm is an unusual finding (18,21), and wide excision may not to be warranted routinely for clearance of lateral nodes (16).…”

“…the division of the material in quartiles cannot be interpreted as performing cME or not, it rather indicates the extension of mesenteric excision. Besides the level of the central ligature, other factors such as tumor location (16,17), tumor stage (18), and presence of obstruction influence resection size. However, no differences in tumor stage and anatomical distribution of the tumors were noted between the groups, pointing that the surgeons' preference was the main determinate for resection length.…”