• Indocyanine green
• Lymphatic drainage pathways
• Mid-low rectal cancer
• Radical surgery

• Humans
• Indocyanine Green
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Male
• Female
• Lymph Node Excision/methods
• Prospective Studies
• Middle Aged
• Aged
• Lymphatic Metastasis
• Laparoscopy/methods
• Coloring Agents
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Adult
• Length of Stay/statistics & numerical data
• Neoplasm Staging

• D3 lymph node dissection
• Descending colon cancer
• Inferior mesenteric artery
• Laparoscopic colectomy

• Humans
• Colon, Descending/pathology
• Mesenteric Artery, Inferior/surgery
• Retrospective Studies
• Propensity Score
• Potassium Iodide
• Lymph Node Excision
• Colonic Neoplasms/surgery
• Colonic Neoplasms/pathology
• Laparoscopy
• Ligation

• Aged
• Colectomy/methods
• Female
• Humans
• Male
• Mesocolon/surgery
• Middle Aged
• Prospective Studies
• Sigmoid Neoplasms/surgery
• Single-Blind Method
• Treatment Outcome

• CME
• Colon cancer
• Complete mesocolic excision
• Lymph node yield
• Meta-analysis
• Safety

• Colectomy
• Colonic Neoplasms/surgery
• Humans
• Laparoscopy
• Lymph Node Excision
• Lymph Nodes/surgery
• Mesocolon/surgery
• Treatment Outcome

• Università degli Studi di Perugia

• practice guideline
• rectal cancer
• surgery
• treatment

This study aimed to explore the pathological characteristics of lymph nodes around inferior mesenteric artery in rectal cancer and its risk factors and its impact on tumor staging.

485 rectal cancer patients underwent proctectomy surgery were collected in this study. Clinical features of patients, including gender, age, BMI, tumor size, pathological type, differentiation, nerve invasion, lymph nodes, tumor marker, and pathological examinations, were analyzed.

A total of 485 cases were included in this study. There were 29 cases with IMA-LN metastasis; the metastasis rate was 5.98% (29/485). Positive IMA-LNs were associated with distance from anal verge, CEA, pathological type, differentiation, nerve invasion, T stage, and N stage. Multivariate analysis showed that distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs.

Distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. No skip metastasis occurred in IMA-LNs. We should choose the appropriate surgical methods to achieve better oncological results and reduce the incidence of postoperative complications.

• High ligation
• Inferior mesenteric artery
• Lymph nodes metastasis
• Pathological features
• Rectal cancer

Conventional clinical guidelines recommend that at least 12 lymph nodes should be removed during radical rectal cancer surgery to achieve accurate staging. The current application of neoadjuvant therapy has changed the number of lymph node dissection.

To investigate factors affecting the number of lymph nodes dissected after neoadjuvant chemoradiotherapy in locally advanced rectal cancer and to evaluate the relationship of the total number of retrieved lymph nodes (TLN) with disease-free survival (DFS) and overall survival (OS).

A total of 231 patients with locally advanced rectal cancer from 2015 to 2017 were included in this study. According to the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification system and the NCCN guidelines for rectal cancer, the patients were divided into two groups: group A (TLN ≥ 12, n = 177) and group B (TLN < 12, n = 54). Factors influencing lymph node retrieval were analyzed by univariate and binary logistic regression analysis. DFS and OS were evaluated by Kaplan-Meier curves and Cox regression models.

The median number of lymph nodes dissected was 18 (range, 12-45) in group A and 8 (range, 2-11) in group B. The lymph node ratio (number of positive lymph nodes/total number of lymph nodes) (P = 0.039) and the interval between neoadjuvant therapy and radical surgery (P = 0.002) were independent factors of the TLN. However,TLN was not associated with sex, age, ASA score, clinical T or N stage, pathological T stage, tumor response grade (Dworak), downstaging, pathological complete response, radiotherapy dose, preoperative concurrent chemotherapy regimen, tumor distance from anal verge, multivisceral resection, preoperative carcinoembryonic antigen level, perineural invasion, intravascular tumor embolus or degree of differentiation. The pathological T stage (P < 0.001) and TLN (P < 0.001) were independent factors of DFS, and pathological T stage (P = 0.011) and perineural invasion (P = 0.002) were independent factors of OS. In addition, the risk of distant recurrence was greater for TLN < 12 (P = 0.009).

A shorter interval to surgery after neoadjuvant chemoradiotherapy for rectal cancer under indications may cause increased number of lymph nodes harvested. Tumor shrinkage and more extensive lymph node retrieval may lead to a more favorable prognosis.

• Lymph node retrieval
• Survival analysis
• Neoadjuvant therapy
• Rectal cancer
• Tumor-node-metastasis stage
• Prognosis

• Adjuvant chemotherapy
• Colorectal cancer
• Indocyanine green
• Micrometastases
• Sentinel lymph node
• Upstaging

Colorectal cancer is the third most commonly diagnosed cancer worldwide. Lymph node (LN) retrieval is a key factor for pathologic staging and prognosis of colorectal cancer. Increase in number of LNs removal suggests improvement in tumour clearance and decrease in metastatic spread. Studies have suggested that excising 12 or more LNs during colectomy in patients with colon cancer is associated with improved survival. To date, there have been no studies to determine whether minimally invasive surgery affects the ability to retrieve 12+ LNs in elective colon cancer surgery. Therefore, we elected to determine whether a difference exists on the ability to retrieve 12+ nodes in elective colon cancer colectomies performed open versus laparoscopic.

The National Surgical Quality Improvement Program (NSQIP) Procedure Specific Colectomy database was analysed for the year 2014–2015. Inclusion criteria were colon cancer (ICD-9 Code 153.9), age greater than 18 years. Exclusion criteria were missing data. Data abstracted included patient demographics, type of operation performed and number of LNs retrieved. The patients were categorised based on their elective colon cancer colectomies such as laparoscopic or open. Binary logistic regression was used to identify confounding variables in the retrieval of 12+ LNs.

After accounting for missing cases, a total of 18,792 patients with a diagnosis of colon cancer were analysed. Twelve or more LNs were retrieved in 88% (16,538) of patients, Among them, 2,516 patients underwent laparoscopic colectomy and 5,284 patients underwent open colectomy. The difference was not statistically significant for the average number of LNs retrieved among both the groups. Open operative approach compared to the laparoscopic approach was associated with 15% greater odds of retrieval of >12 LNs (OR 1.148; 95% CI (1.035–1.272); p = 0.008).

The majority of colectomies such as open or laparoscopic are able to retrieve 12 or more LNs. However, there are greater odds of retrieving more than 12 LNs with the open approach compared to the laparoscopic approach. By allowing for more LN retrieval, open colectomies suggest improvement in tumour clearance and decrease metastatic spread. Additional research is needed to further investigate the specific factors influencing the ability to retrieve an adequate number of LNs, such as viewing angles provided with an open approach versus laparoscopic approach.

• Colon cancer
• laparoscopic colectomy
• lymph nodes

• Colon/blood supply
• Colon/embryology
• Colonic Neoplasms/mortality
• Colonic Neoplasms/surgery
• Feasibility Studies
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Lymph Node Excision
• Mesocolon/embryology
• Mesocolon/surgery
• Neoplasm Grading/methods
• Neoplasm Recurrence, Local/prevention & control
• Postoperative Complications/etiology
• Survival Rate

• 3D imaging
• colon cancer
• laparoscopic surgery

To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart.

We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies.

A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm², 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall (OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I² = 28%) and disease-free (OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I² = 0%) survival.

The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.

• Colon cancer
• Complete mesocolic excision
• D3 lymphadenectomy
• Central vascular ligation

• Colon cancer
• complete mesocolic excision
• meta-analysis

• Adult
• Aged
• Colectomy/adverse effects
• Colectomy/methods
• Colonic Neoplasms/surgery
• Disease-Free Survival
• Female
• Humans
• Lymph Node Excision/statistics & numerical data
• Lymph Nodes/surgery
• Male
• Mesocolon/surgery
• Middle Aged
• Operative Time
• Outcome Assessment, Health Care
• Postoperative Complications/etiology
• Postoperative Complications/mortality