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Flemming S. [Extended Complete Mesocolic Excision in right-sided Colon Cancer - An Overview]. Zentralbl Chir 2025; 150:158-162. [PMID: 40199373 DOI: 10.1055/a-2537-7546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
Surgical resection with systematic lymphadenectomy remains the standard of care for non-metastasised colon cancer. After the article of Hohenberger et al. in 2009 describing the surgical technique of complete mesocolic excision (CME), D2 lymphadenectomy has been called into doubt after the finding of a better oncological outcome. However, there has been also a controversial discussion about the oncological value of CME, since intraoperative complications may increase. Additional evidence has been provided in recent years from randomised controlled multicentre studies showing that the reported improved oncological long-term outcome after CME is more than questionable. The reported increased rate of intraoperative (vascular) complications could be not confirmed.
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Affiliation(s)
- Sven Flemming
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
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Park HM, Lee J, Lee SY, Heo SH, Jeong YY, Kim HR, Kim CH. Optimal extent of lymph node dissection in clinical early-stage right colon cancer: a retrospective analysis. Ann Surg Treat Res 2025; 108:49-56. [PMID: 39823033 PMCID: PMC11735168 DOI: 10.4174/astr.2025.108.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 10/28/2024] [Accepted: 11/02/2024] [Indexed: 01/19/2025] Open
Abstract
Purpose Determining the extent of radical lymphadenectomy at clinical early stage is challenging. We aimed to investigate the appropriate extent of lymphadenectomy in clinical early-stage right colon cancer. Methods Patients with clinical stage 0 or I right colon cancer who underwent curative surgery from January 2007 to December 2021 were included in this retrospective study. The extent of lymph node (LN) metastases based on the distribution of LN metastases (LND: LND1 pericolic nodes, LND2 intermediate nodes, LND3 apical nodes), along with the depth of submucosal (SM) invasion (classed into SM1-3), were analyzed. Results Of the 348 patients, distribution across pathologic stages was as follows: 30 patients (8.6%) at stage 0, 207 (59.5%) at stage I, 52 (14.9%) at stage II, and 59 (17.0%) at stage III. In pT1 tumor patients, LN metastases varied by SM invasion depth: 3.6% in SM1 (all LND1), 5.1% in SM2 (all LND1), and 17.5% in SM3 (LND1 10%, LND2 5%, LND3 2.5%). For pT2, pT3, and pT4 stages, LN metastasis rates were 16.2% (LND1 11.3%, LND2 3.8%, LND3 1.3%), 39.7% (LND1 28.9%, LND2 8.4%, LND3 2.4%), and 50% (LND1 25%, LND2 25%), respectively. Tumor invasion depth and lymphovascular invasion were identified as significant risk factors for LN metastasis extending to LND2-3. Conclusion Complete mesocolic excision should be considered for right-sided colon cancer because tumor infiltration deeper than SM2 could metastasize to LND2 or further. If preoperative endoscopy confirms SM1 or SM2 invasion, D2 lymphadenectomy could be a limited surgical option.
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Affiliation(s)
- Hyeung-min Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Noda K, Tominaga T, Nonaka T, Ono R, Oishi K, Takamura Y, Ishii M, Hisanaga M, Takeshita H, Oyma S, Ishimaru K, Nagayasu T. Prognostic value of lymph node distribution after laparoscopic colectomy with Japanese D3 dissection. Langenbecks Arch Surg 2024; 409:28. [PMID: 38183468 DOI: 10.1007/s00423-023-03222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Positive pathologic lymph nodes in colorectal cancer represent an important prognostic indicator. Whether lymph node distribution or the number of metastatic nodes is more strongly associated with survival prediction remains controversial. METHODS Among 3449 colorectal cancer surgeries performed at Nagasaki University Hospital and five affiliated institutions from April 2016 to March 2022, we investigated 604 patients who underwent laparoscopic radical resection and were diagnosed with pathological stage III cancer. Patients were divided into two groups according to whether they had central vessel metastasis (LND3 group, n=42) or not (LND1/2 group, n=562). After adjusting for background factors using propensity score matching, the LND3 group included 42 patients and the LND1/2 group included 40 patients. Patient background characteristics and prognosis were compared between these two groups. RESULTS Before matching, frequencies of right-side colon cancer (64.3% vs 38.1%, p=0.001), multivisceral resection (11.9% vs 4.4%, p=0.039), clinical N2 status (40.5% vs 22.6%, p=0.032), and pathological N2 (73.8% vs 22.6%, p<0.001) were all greater, and the number of lymph nodes retrieved was higher (24 vs 19, p=0.042) in the LND3 group. After matching, no differences in any clinical factors were evident between groups. Five-year RFS (44.8% vs 77.1%, p=0.004) and OS (43.1% vs 83.2%, p<0.001) were worse in the LND3 group. Adjuvant chemotherapy improved RFS (adjuvant chemotherapy (+) vs adjuvant chemotherapy (-): 62.1% vs 27.7%, p=0.047) in the LND3 group. CONCLUSION LND3-positive patients show poorer prognosis than LND1/2 patients and should be treated with an appropriate perioperative treatment strategy.
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Affiliation(s)
- Keisuke Noda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Department of Surgery, Isahaya General Hospital, 24-1 Isahaya, Nagasaki, 854-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Rika Ono
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kaido Oishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsutoshi Ishii
- Department of Surgery, Isahaya General Hospital, 24-1 Isahaya, Nagasaki, 854-8501, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, 1-1001-1 Omura, Nagasaki, 856-8562, Japan
| | - Shosaburo Oyma
- Department of Surgery, Ureshino Medical Center, 4279-3 Ureshino, Saga, 843-0393, Japan
| | - Kazuhide Ishimaru
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Pennings AJ, van der Velden BA, Kloft M, Kooreman LFS, Kleijnen JMP, Breukink SO, Beets GL, Grabsch HI, Melenhorst J. The Role of Nonmetastatic Lymph Nodes in the Survival of Colorectal Cancer: A Systematic Review. ANNALS OF SURGERY OPEN 2023; 4:e336. [PMID: 38144501 PMCID: PMC10735087 DOI: 10.1097/as9.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 12/26/2023] Open
Abstract
Objective In this review, we aim to provide an overview of literature on lymph node (LN) histomorphological features and their relationship with the prognosis in colorectal cancer (CRC). Background Lymph nodes play a crucial role in the treatment and prognosis of CRC. The presence of LN metastases considerably worsens the prognosis in CRC patients. Literature has shown that the total number of LNs and the number negative LNs (LNnegs) has prognostic value in CRC patients. In esophageal carcinoma, LN size seems to be surrogate of the host antitumor response and a potentially clinically useful new prognostic biomarker for (y)pN0 esophageal carcinoma. Methods A comprehensive search was performed in Pubmed, Embase, Medline, CINAHL, and the Cochrane library in March 2021. The PRISMA guidelines were followed. Only studies focusing on histomorphological features and LN size and their relation to overall survival were selected. Results A total of 9 unique articles met all inclusion criteria and were therefore included in this systematic review. Six of these studies investigated HMF (eg, paracortical hyperplasia, germinal center predominance, and sinus histiocytosis) and 4 studies LNneg size and their relationship with overall survival. The presence of paracortical hyperplasia and an increased number of large LNnegs is related to a more favorable prognosis in CRC. Conclusion The results of this systematic review seem to support the hypothesis that there is a relationship between the host antitumor response reflected in different histomorphological reaction patterns visible in LNnegs and LNneg size related to survival in CRC patients.
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Affiliation(s)
- Alexander J. Pennings
- From the Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Brecht A. van der Velden
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Maximilian Kloft
- Department of Pathology, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Internal Medicine IV, Justus-Liebig-University, University Hospital Giessen and Marburg, Giessen, Germany
| | - Loes F. S. Kooreman
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M. P. Kleijnen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Stephanie O. Breukink
- From the Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Geerard L. Beets
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Heike I. Grabsch
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, the Netherlands
- Pathology & Data Analytics, Leeds Institute of Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Jarno Melenhorst
- From the Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Tsukamoto S, Ouchi A, Komori K, Shiozawa M, Yasui M, Ohue M, Nogami H, Takii Y, Moritani K, Kanemitsu Y. A multicenter prospective observational study of lymph node metastasis patterns and short-term outcomes of extended lymphadenectomy in right-sided colon cancer. Ann Gastroenterol Surg 2023; 7:940-948. [PMID: 37927926 PMCID: PMC10623977 DOI: 10.1002/ags3.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/17/2023] [Accepted: 05/13/2023] [Indexed: 11/07/2023] Open
Abstract
Background The lymph node metastasis rate in right-sided colon cancer is unknown, and the optimal central vascular ligation level remains controversial. We aimed to determine the lymph node metastasis rate and short-term results of radical surgery with extended lymph node dissection in right-sided colon cancer. Methods This prospective multicenter observational study included patients with stage II/III right-sided colon cancer from five cancer hospitals. The metastasis rate of each node station was analyzed according to tumor location and main feeding artery. Results Between April 2018 and August 2021, 208 patients underwent dissection around the superior mesenteric artery (SMA) and vein (SMV). In transverse colon cancer, 7.5% and 2.5% of metastases occurred around the SMV and SMA at the root of the middle colic artery (MCA), respectively; 6.7% and 6.7% at the root of the right colic artery. In caecal cancer, 1.9% of metastases occurred around the SMV and 1.9% around the SMA. In ascending colon cancer, the rate was 1.1% around the SMV. Of the tumors, 17% fed mainly by the ileocolic artery had node metastases along the middle or right colic artery, as did 66.7% fed mainly by the right colic artery and 41.2% fed by the MCA (p = 0.01). Postoperative complications occurred in 42 patients (20.2%). Conclusion Routine prophylactic extended lymphadenectomy around the SMA might not be necessary in caecum and ascending colon cancer. Dissection around the SMA may be necessary in cases of transverse colon cancer or when the feeding artery is the MCA.
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Affiliation(s)
- Shunsuke Tsukamoto
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Akira Ouchi
- Department of Gastroenterological SurgeryAichi Cancer Center HospitalAichiJapan
| | - Koji Komori
- Department of Gastroenterological SurgeryAichi Cancer Center HospitalAichiJapan
| | - Manabu Shiozawa
- Department of Gastroenterological SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Masayoshi Yasui
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masayuki Ohue
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hitoshi Nogami
- Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Yasumasa Takii
- Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Konosuke Moritani
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
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Lei YP, Song QZ, Liu S, Xie JY, Lv GQ. Predicting lymph node metastasis in colorectal cancer: An analysis of influencing factors to develop a risk model. World J Gastrointest Surg 2023; 15:2234-2246. [PMID: 37969707 PMCID: PMC10642478 DOI: 10.4240/wjgs.v15.i10.2234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a significant global health issue, and lymph node metastasis (LNM) is a crucial prognostic factor. Accurate prediction of LNM is essential for developing individualized treatment strategies for patients with CRC. However, the prediction of LNM is challenging and depends on various factors such as tumor histology, clinicopathological features, and molecular characteristics. The most reliable method to detect LNM is the histopathological examination of surgically resected specimens; however, this method is invasive, time-consuming, and subject to sampling errors and interobserver variability. AIM To analyze influencing factors and develop and validate a risk prediction model for LNM in CRC based on a large patient queue. METHODS This study retrospectively analyzed 300 patients who underwent CRC surgery at two Peking University Shenzhen hospitals between January and December 2021. A deep learning approach was used to extract features potentially associated with LNM from primary tumor histological images while a logistic regression model was employed to predict LNM in CRC using machine-learning-derived features and clinicopathological variables as predictors. RESULTS The prediction model constructed for LNM in CRC was based on a logistic regression framework that incorporated machine learning-extracted features and clinicopathological variables. The model achieved high accuracy (0.86), sensitivity (0.81), specificity (0.87), positive predictive value (0.66), negative predictive value (0.94), area under the curve for the receiver operating characteristic (0.91), and a low Brier score (0.10). The model showed good agreement between the observed and predicted probabilities of LNM across a range of risk thresholds, indicating good calibration and clinical utility. CONCLUSION The present study successfully developed and validated a potent and effective risk-prediction model for LNM in patients with CRC. This model utilizes machine-learning-derived features extracted from primary tumor histology and clinicopathological variables, demonstrating superior performance and clinical applicability compared to existing models. The study provides new insights into the potential of deep learning to extract valuable information from tumor histology, in turn, improving the prediction of LNM in CRC and facilitate risk stratification and decision-making in clinical practice.
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Affiliation(s)
- Yun-Peng Lei
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Qing-Zhi Song
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Shuang Liu
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Ji-Yan Xie
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Guo-Qing Lv
- Department of Gastrointestinal Surgery, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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Qu X, Zhou D, Lu J, Qin D, Zhou J, Liu HJ. Cancer nanomedicine in preoperative therapeutics: Nanotechnology-enabled neoadjuvant chemotherapy, radiotherapy, immunotherapy, and phototherapy. Bioact Mater 2023; 24:136-152. [PMID: 36606253 PMCID: PMC9792706 DOI: 10.1016/j.bioactmat.2022.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Surgical resection remains a mainstay in the treatment of malignant solid tumors. However, the use of neoadjuvant treatments, including chemotherapy, radiotherapy, phototherapy, and immunotherapy, either alone or in combination, as a preoperative intervention regimen, have attracted increasing attention in the last decade. Early randomized, controlled trials in some tumor settings have not shown a significant difference between the survival rates in long-term neoadjuvant therapy and adjuvant therapy. However, this has not hampered the increasing use of neoadjuvant treatments in clinical practice, due to its evident downstaging of primary tumors to delineate the surgical margin, tailoring systemic therapy response as a clinical tool to optimize subsequent therapeutic regimens, and decreasing the need for surgery, with its potential for increased morbidity. The recent expansion of nanotechnology-based nanomedicine and related medical technologies provides a new approach to address the current challenges of neoadjuvant therapy for preoperative therapeutics. This review not only summarizes how nanomedicine plays an important role in a range of neoadjuvant therapeutic modalities, but also highlights the potential use of nanomedicine as neoadjuvant therapy in preclinical and clinic settings for tumor management.
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Affiliation(s)
- Xiaogang Qu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, China
| | - Dong Zhou
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, China
| | - Jianpu Lu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, China
| | - Duotian Qin
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jun Zhou
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Hai-Jun Liu
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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A Clinicopathological Feature-Based Nomogram for Predicting the Likelihood of D3 Lymph Node Metastasis in Right-Sided Colon Cancer Patients. Dis Colon Rectum 2023; 66:75-86. [PMID: 34897214 DOI: 10.1097/dcr.0000000000002160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite advancements in treating right-sided colon cancer patients, the ideal scope of lymphadenectomy remains controversial. OBJECTIVE Our objective was to investigate the likelihood of D3 lymph node metastasis in right-sided colon cancer patients and develop a clinicopathological feature-based nomogram for D3 lymphadenectomy. DESIGN We retrospectively analyzed 286 right-sided colon cancer patients who underwent D3 lymphadenectomy. The patients were divided into 2 groups based on whether D3 lymph node metastasis was positive. Then, univariable and multivariable logistic regression analyses were performed to obtain independent risk factors for predicting D3 lymph node metastasis. Moreover, we performed receiver operating characteristic curve analyses to evaluate the predictive power of the model. SETTING This study was conducted at Nanfang Hospital of Southern Medical University in China. PATIENTS A total of 286 consecutive patients who underwent right hemicolectomy and D3 lymphadenectomy as a primary treatment for right-sided colon cancer between January 2016 and December 2019 were enrolled in this study. MAIN OUTCOME MEASURES The primary measures were independent risk factors for predicting D3 lymph node metastasis in right-sided colon cancer. RESULTS The D3 lymph node metastasis rate in right-sided colon cancer patients was 16.1% (46/286). D3 lymphadenectasis on CT, lymphatic invasion, and T4 tumors were filtered out as independent risk factors for D3 lymph node metastasis according to the multivariable logistic regression analysis. We established a nomogram that predicted D3 lymph node metastasis of right-sided colon cancer on the combination of the 3 factors with an area under the curve of 0.717 (95% CI, 0.629-0.806). LIMITATIONS This was a retrospective study from a single center. CONCLUSIONS We developed a valuable clinicopathological feature-based nomogram to predict the incidence of D3 lymph node metastasis in right-sided colon cancer patients. Patients with D3 lymphadenectasis on CT, preoperative T4 tumors, and lymphatic invasion should undergo D3 lymphadenectomy. See Video Abstract at http://links.lww.com/DCR/B852 . UN NOMOGRAMA BASADO EN CARACTERSTICAS CLNICOPATOLGICAS PARA PREDECIR LA PROBABILIDAD DE METSTASIS EN GANGLIOS LINFTICOS D EN PACIENTES CON CNCER DE COLON DERECHO ANTECEDENTES:A pesar de los avances en el tratamiento de pacientes con cáncer de colon derecho, el ámbito ideal de la linfadenectomía sigue siendo controvertido.OBJETIVO:Investigar la probabilidad de metástasis en los ganglios linfáticos D3 en pacientes con cáncer de colon derecho y desarrollar un nomograma basado en características clínico-patológicas basado para la linfadenectomía D3.DISEÑO:Analizamos retrospectivamente a 286 pacientes con cáncer de colon derecho que se sometieron a linfadenectomía D3. Los pacientes se dividieron en dos grupos en función de si eran positivos para metástasis en los ganglios linfáticos D3. Luego, se realizaron análisis de regresión logística univariable y multivariable para obtener factores de riesgo independientes para predecir metástasis en los ganglios linfáticos D3. Además, realizamos análisis de las curvas de características operatorias del receptor para evaluar el poder predictivo del modelo.SEDE:Este estudio se realizó en el Hospital Nanfang de la Universidad Médica del Sur en China.PACIENTES:Un total de 286 pacientes consecutivos que se sometieron a hemicolectomía derecha y linfadenectomía D3 como tratamiento primario para el cáncer de colon derecho entre enero de 2016 y diciembre de 2019 se inscribieron en este estudio.PRINCIPALES MEDIDAS DE RESULTADO:Las medidas primarias fueron factores de riesgo independientes para predecir las metástasis en ganglios linfáticos D3 en el cáncer de colon derecho.RESULTADOS:La tasa de metástasis en los ganglios linfáticos D3 en pacientes con cáncer de colon del lado derecho fue del 16,1% (46/286). El aumento de tamaño de ganglios D3 en la TC, la invasión linfática y los tumores T4 se filtraron como factores de riesgo independientes de metástasis en los ganglios linfáticos D3 de acuerdo con el análisis de regresión logística multivariable. Establecimos un nomograma que predijo metástasis en los ganglios linfáticos D3 del cáncer de colon derecho en la combinación de los tres factores con un área bajo la curva de 0,717 (IC del 95%, 0,629-0,806).LIMITACIONES:Este fue un estudio retrospectivo de un solo centro.CONCLUSIONES:Desarrollamos un valioso nomograma basado en características clínico-patológicas para predecir la incidencia de metástasis en los ganglios linfáticos D3 en pacientes con cáncer de colon derecho. Los pacientes con crecimiento de ganglios D3 en TC, tumores con clasificación preoperatoria T4 e invasión linfática, deben ser sometidos a linfadenectomía D3. Consulte Video Resumen en http://links.lww.com/DCR/B852 . (Traducción-Dr. Juan Carlos Reyes ).
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The prognostic significance of apical lymph node metastasis in patients with high-risk stage III colon cancer. Sci Rep 2022; 12:2059. [PMID: 35136136 PMCID: PMC8825832 DOI: 10.1038/s41598-022-06054-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
The effect of apical lymph node (APN) metastasis on the prognosis of colon cancer is unknown. The present study investigated the impact of APN metastasis on the prognosis of the patients with high-risk stage III colon cancer. This retrospective multi-institutional study included patients with pathological high-risk stage III colon cancer who underwent surgery between April 2009 and December 2014. Clinicopathological factors were examined by univariate and multivariate analyses to clarify independent risk factors for overall survival (OS) and relapse-free survival (RFS). A total of 185 patients were collected. The 5-year OS rates of patients with and without APN metastasis were 35.0% and 72.1%, respectively (p = 0.0014). The 5-year RFS rates of patients with and without APN metastasis was 16.2% and 57.2%, respectively (p = 0.0002). The rate of distant metastasis in patients with APN metastasis was significantly higher than that in patients without APN metastasis (68.8% vs. 36.7%, p = 0.012). The univariate analysis revealed that the differentiation, lymph node ratio, and APN metastasis were significantly associated with 5-year OS, and the preoperative CEA and CA19-9 levels and APN metastasis were significantly associated with 5-year RFS. The multivariate analysis showed that APN metastasis was an independent risk factor for 5-year OS and RFS. APN metastasis may be independently associated with the prognosis of patients with high-risk Stage III colon cancer.
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10
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Zhou S, Shen Y, Huang C, Li G. Prognosis of Patients With Colorectal Cancer and Apical Lymph Node Metastasis at the Inferior Mesenteric Artery: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:800717. [PMID: 35111781 PMCID: PMC8802690 DOI: 10.3389/fmed.2021.800717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background This review was designed to compile the evidence on the prognosis of patients with colorectal cancer and apical lymph node (APN) metastasis and the long-term benefit of inferior mesenteric artery lymph node (IMA-LN) resection. Methods We searched the PubMed Central, Cochrane library, EMBASE, and MEDLINE databases from inception until May 2021 for relevant publications. We assess the quality of the studies using the Newcastle Ottawa scale. We conducted a random-effects model meta-analysis and report pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Results We analyzed data from 13 studies conducted in Japan, China, and Korea with 6,193 participants. Most studies were retrospective in nature and of low quality. We found that patients with APN metastasis had shorter OSs (pooled HR, 2.41; 95% CI, 1.92–3.02) and PFSs (pooled HR, 2.42; 95% CI, 1.90–3.09) than the patients without the metastasis. We identified significant heterogeneity without publication bias for both outcomes. Moreover, our sensitivity analysis revealed robust estimates were robust for the individual effects. Conclusion Our findings suggest that patients with colorectal cancer and APN metastases have significantly worse OS and DFS than those without the metastasis. However, inclusion of low-quality retrospective studies with high heterogeneity limits the generalizability of study findings.
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11
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Chen B, Liu X, Zhang Y, Zhuang J, Peng Y, Wang Y, Wu Y, Li S, Yang Y, Guan G. Prognostic Value of the Distribution of Lymph Node Metastasis in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy. Front Surg 2021; 8:749575. [PMID: 34869558 PMCID: PMC8635484 DOI: 10.3389/fsurg.2021.749575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The objective of this study is to assess the prognostic value of lymph node metastasis distribution (LND) in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT). Methods: This study included 179 patients with pathological stage III LARC who underwent nCRT followed by radical surgery. LND was classified into three groups: LND1, lymph node metastasis at the mesorectum (140/179, 78.2%); LND2, lymph node metastasis along the inferior mesenteric artery trunk nodes (26/179, 14.5%); LND3, lymph node metastasis at the origin of the IMA (13/179, 7.3%). Clinicopathologic characteristics were analyzed to identify independent prognostic factors. Result: LND showed better stratification for 3-year DFS (LND1 66.8, LND2 50, and LND3 15.4%, P < 0.01) compared to the ypN (3-year DFS: N1 59.9 and N2 60.3%, P = 0.34) and ypTNM (3-year DFS: IIIA 68.6%, IIIB 57.5%, and IIIC 53.5, P = 0.19) staging systems. Similar results were found for 3-year LRFS and DMFS. According to multivariate survival analysis, LND was shown to be an independent prognostic factor for DFS, LRFS, and DMFS in patients with positive lymph nodes (P < 0.01, in all cases). Conclusion: LND is an independent prognostic factor in stage III rectal cancer after nCRT. LND can be used as a supplementary indicator for the ypTNM staging system in patients with LARC after nCRT.
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Affiliation(s)
- Bin Chen
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xing Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yiyi Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jinfu Zhuang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yong Peng
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ye Wang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yong Wu
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shoufeng Li
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuanfeng Yang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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12
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Tattooing or Metallic Clip Placement? A Review of the Outcome Surrounding Preoperative Localization Methods in Minimally Invasive Anterior Resection Performed at a Single Center. Surg Laparosc Endosc Percutan Tech 2021; 32:101-106. [PMID: 34653111 PMCID: PMC8812424 DOI: 10.1097/sle.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND For minimally invasive colorectal surgery, preoperative localization is a typical procedure. We here aimed to analyze compared 2 different localization methods in terms of short-term outcomes, like the operative outcome and postoperative complication rates based on real-world data. MATERIALS AND METHODS This was a retrospective analysis study conducted at a medical center. We enrolled patients who were presented with colonic tumor between January 1, 2016, and December 31, 2019, and they had undergone laparoscopic anterior resection in a single institution. Data included patient characteristics, operative outcome, length of hospital stay, and postoperative complications. RESULTS The preoperative localization group had a better resection margin (4 vs. 3 cm; P<0.001) and fewer procedures of intraoperative colonoscopy (4.67% vs. 18.22%; P=0.002). Lymph node harvest occurred more in patients with endoscopic tattooing procedures than with metallic clip procedures (25 vs. 20; P=0.031). No significant difference was found regarding postoperative complications and the length of hospital stay. CONCLUSIONS Preoperative localization in a laparoscopic anterior resection led to better surgical planning and resection margin. The metallic clip placement was helpful in the preoperative localization and setting. The endoscopic tattooing method had a larger lymph node harvest and with fewer intraoperative colonoscopy.
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13
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Balciscueta Z, Balciscueta I, Uribe N, Pellino G, Frasson M, García-Granero E, García-Granero Á. D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:1541-1551. [PMID: 33676793 DOI: 10.1016/j.ejso.2021.02.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND D3-Lymphadenectomy, together with complete mesocolic excision (CME), were introduced to provide oncological results after right colon cancer. The aim of this systematic review with meta-analysis was to assess the short and long-term outcomes of right-sided hemicolectomy with CME + D3 as compared with classic right hemicolectomy. Secondary aims included the prevalence of D3-metastasis and skip metastasis when performing CME + D3. MATERIAL AND METHODS A systematic review with meta-analysis was conducted, according to PRISMA methodology. RESULTS 29 studies were enrolled (2592 patients). No differences were accounted in morbidity variables associated with the measured techniques. CME + D3 was significantly associated with a greater distance between the tumour and the closest vascular tie, a longer colonic resection, a wider resection of mesentery and an increased number of harvested lymph nodes. Regarding to long-terms outcomes, we found a significant decrease in local recurrence in patients undergoing CME + D3 (HR:0.17) and a significant improvement in 3-year and 5-year overall survival rates (HR:0.53 vs. HR:0.57, respectively), as well as an improving survival in patients with stage II and III disease. Overall prevalence of patients with lymphatic metastases in D3-territory was of 8.6% and 2.2% of skip metastases. CONCLUSIONS CME + D3 is a feasible surgical procedure that allows to obtain specimens with higher quality oncological resection, without greater associated morbidity, thus improving survival in patients with stage II and III right colon cancer.
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Affiliation(s)
| | - Izaskun Balciscueta
- Department of General and Digestive Surgery, Hospital Universitario La Ribera, Alzira, Valencia, Spain.
| | - Natalia Uribe
- Colorectal Surgery Unit, Hospital Arnau de Vilanova, Valencia, Spain.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Matteo Frasson
- Colorectal Surgery Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
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14
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Guidolin K, Covelli A, Chesney TR, Draginov A, Chadi SA, Quereshy FA. Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer. Surg Open Sci 2021; 5:1-5. [PMID: 34337371 PMCID: PMC8313841 DOI: 10.1016/j.sopen.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023] Open
Abstract
Background Low ligation of the inferior mesenteric artery with preservation of the left colic artery may decrease the risk of colorectal anastomotic ischemia compared to high ligation at its origin. Low ligation leaves apical nodes in situ and is therefore paired with apical lymphadenectomy. We sought to compare relevant oncologic outcomes between high ligation and low ligation plus apical lymphadenectomy in rectosigmoid resection for colorectal cancer. Methods We conducted a retrospective cohort study. Patients receiving a rectosigmoid resection for cancer between January 2012 and July 2018 were included. Patients with metastatic disease and those who underwent low ligation without apical lymphadenectomy were excluded. Our primary outcome was nodal yield/metastasis. Secondary outcomes included perioperative complications, local recurrence, and overall survival. Results Eighty-four patients underwent high ligation and 89 low ligation plus apical lymphadenectomy (median follow-up 20 months). In the low-ligation group, a median of 2 (interquartile range = 1–3) apical nodes was resected; 4.1% were malignant, increasing pathologic stage in 25% of these patients. There were no differences in nodal yield, complications, anastomotic leak, local recurrence, or overall survival. Conclusion No differences were identified between high ligation and low ligation plus apical lymphadenectomy with respect to relevant clinical outcomes. Prospective trial data are needed to robustly establish the oncologic benefit and safety of the low ligation plus apical lymphadenectomy technique.
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Affiliation(s)
- Keegan Guidolin
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | - Andrea Covelli
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Department of Surgery, University Health Network, Toronto, Ontario
| | - Tyler R Chesney
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Department of Surgery, St. Michael's Hospital, Toronto, Ontario
| | - Arman Draginov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | - Sami A Chadi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Department of Surgery, University Health Network, Toronto, Ontario
| | - Fayez A Quereshy
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Department of Surgery, University Health Network, Toronto, Ontario
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15
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Huang X, Liu H, Liao X, Xiao Z, Huang Z, Li G. Prognostic factors for T1-2 colorectal cancer after radical resection: Lymph node distribution is a valuable predictor of its survival. Asian J Surg 2021; 44:241-246. [PMID: 32792113 DOI: 10.1016/j.asjsur.2020.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The prognostic factors for patients with T1-2 colorectal cancer (CRC) after radical resection and the predictive value of lymph node distribution (LND) system compared with TNM system for these patients have not been well studied. METHODS From September 2009 and June 2016, a total of 541 consecutive patients with T1-2 CRC who accepted radical resection in two centers were included in this study. Their clinicopathological characteristics and prognosis were analyzed using univariate and multivariate Cox regression analyses. The predictive value of LND system for these patients were compared with the TNM system. RESULTS Univariate analysis revealed that patients' gender, tumor size, LNM and lymphovascular or nerve invasion were prognostic factors for the disease-free survival (DFS) (p < 0.05). Multivariate regression analysis confirmed the gender, LNM and lymphovascular or nerve invasion were independent prognostic factors for the DFS (p < 0.05). The LND system had a better predictive value than the TNM system in lymph node-positive T1-2 CRC patients (P = 0.026 vs p = 0.148). CONCLUSIONS The gender, LNM and lymphovascular or nerve invasion were independent prognostic factors for the patients with T1-2 CRC after radical resection. The LND system had a better predictive value than the TNM system in T1-2 CRC patients.
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Affiliation(s)
- Xing Huang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, Guangdong, China; The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang West Road, Changsha, Hunan, China.
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, Guangdong, China
| | - Xiangqi Liao
- The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang West Road, Changsha, Hunan, China
| | - Zhigang Xiao
- The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang West Road, Changsha, Hunan, China
| | - Zhongcheng Huang
- The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang West Road, Changsha, Hunan, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, Guangdong, China.
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16
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Jiang Y, Zou Z, Zhang Z, Zhang Y, Sun Y, Liang B. Long-Term Outcomes of Radical Surgery for Transverse Colon Cancer Staged from I to IIIC. Cancer Manag Res 2020; 12:13043-13049. [PMID: 33376398 PMCID: PMC7765749 DOI: 10.2147/cmar.s244777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background No study has reported the risk factors associated with the prognosis of patients with transverse colon cancer. Therefore, we aimed to demonstrate the long-term outcomes of transverse colon cancer patients undergoing radical surgery and explore the prognostic factors. Materials and Methods The clinical data of a total of 366 patients with transverse colon cancer staged from I to IIIC undergoing radical surgery from February 1992 to May 2017 were retrospectively analyzed. Clinicopathological features were recorded, and univariate and multivariate analyses were conducted to evaluate the association between the factors and overall survival (OS) as well as disease-free survival (DFS). Kaplan–Meier curves were generated to assess the association between TNM stage and OS and DFS, respectively. Results The median follow-up time was 62 months, and the 5-year OS and DFS rates were 87.5% and 86.5%, respectively. In addition, a significant difference was also found in the OS and DFS curves according to TNM stage. The N classification, vascular invasion, differentiation, preoperative CA199, preoperative CA125 and preoperative AFP were significantly associated with OS according to univariate analysis, while N classification and differentiation were independent prognostic factors for OS according to multivariate analysis (both P < 0.05). Similarly, N classification, vascular invasion, differentiation, preoperative CA199, preoperative CA125, and preoperative AFP were statistically correlated with DFS according to univariate analysis, while N classification and preoperative CA199 were independent prognostic factors for DFS according to multivariate analysis (both P < 0.05). Conclusion N classification was an independent factor for both OS and DFS, while differentiation and CA199 were independent prognostic factors only for OS and DFS, respectively.
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Affiliation(s)
- Yaofei Jiang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zulei Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,Department of Cardiac Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Yi Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yuting Sun
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Bo Liang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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17
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Impact of Anatomic Extent of Nodal Metastasis on Adjuvant Chemotherapy Outcomes in Stage III Colon Cancer. Dis Colon Rectum 2020; 63:1455-1465. [PMID: 32969889 DOI: 10.1097/dcr.0000000000001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND An oxaliplatin-based chemotherapy regimen improves the survival outcomes of patients with stage III colon cancer. However, its complications are well-known. OBJECTIVE The purpose of this study was to distinguish between the survival outcomes of patients who underwent curative resection for stage III colon cancer with oxaliplatin chemotherapy and those who underwent such resection without oxaliplatin chemotherapy. DESIGN This was a retrospective analytical study based on prospectively collected data. SETTINGS This study used data on patients who underwent surgery at our hospital between January 2010 and December 2014. PATIENTS A cohort of 254 consecutive patients who underwent curative resection for stage III colon cancer was included in this study. The patients were divided into 2 groups: patients with isolated pericolic lymph node metastasis (n = 175) and those with extrapericolic lymph node metastasis (n = 79). MAIN OUTCOME MEASURES Clinicopathologic features and 3-year survival outcomes were analyzed with and without oxaliplatin therapy in the pericolic lymph node group. RESULTS The pericolic lymph node group showed significantly improved overall survival compared with the extrapericolic lymph node group at a median follow-up of 48.5 months (95.8% vs 77.8%; p < 0.001). In contrast, there was no significant difference in overall survival (99.0% vs 92.0%; p = 0.137) and disease-free survival (89.1% vs 88.2%; p = 0.460) between the oxaliplatin and nonoxaliplatin subgroups of the pericolic lymph node group. Multivariate analysis showed that the administration of oxaliplatin chemotherapy to the pericolic lymph node group did not lead to a significant difference in the overall survival (p = 0.594). LIMITATIONS The study was limited by its retrospective design and single institutional data analysis. CONCLUSIONS This study suggests that the anatomic extent of metastatic lymph nodes could affect patient prognosis, and the effect of oxaliplatin-based adjuvant chemotherapy may not be prominent in stage III colon cancer with isolated pericolic lymph node metastasis.
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18
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Sahara K, Watanabe J, Ishibe A, Goto K, Takei S, Suwa Y, Suwa H, Ota M, Kunisaki C, Endo I. Optimal extent of central lymphadenectomy for right-sided colon cancers: is lymphadenectomy beyond the superior mesenteric vein meaningful? Surg Today 2020; 51:268-275. [PMID: 32710131 DOI: 10.1007/s00595-020-02084-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of the current study was to assess the therapeutic benefit of lymphadenectomy according to the extent of lymphadenectomy. METHODS Patients undergoing colectomy for right-sided colon cancer were identified. Distribution of lymph node metastases (DLNM) of 1, 2 and 3 were defined as lymph node metastasis (LNM) in the pericolic nodes, the intermediate nodes and the front of the SMV near the origin of the major artery, respectively. The therapeutic index (TI) was calculated based on the frequency of LNM and the 5 year overall survival (OS) rate of patients with LNM. RESULTS Among 344 patients who met the inclusion criteria, roughly half had LNM (n = 150, 43.7%). While 107 (31.1%) and 30 (8.7%) patients had DLNM1 and DLNM2, respectively, only 13 patients (3.8%) were defined as DLNM3. However, there was no significant difference in 5 year OS by DLNM (DLNM1 71.1%, DLNM2 78.7%, DLNM3 50.4%, p = 0.61). Overall, the TI of lymphadenectomy for D3 area was approximately 1/10 of the TI for D1 (1.9 vs.22.1), given the low frequency of LNM (3.8%) and poor 5 year OS of patients with LNM (50.4%). This trend was consistent irrespective of primary tumor locations. CONCLUSION The survival benefit from central lymphadenectomy namely D3 was low among patients with right-sided colon cancers.
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Affiliation(s)
- Kota Sahara
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, University Medical Center, Yokohama, Japan.
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koki Goto
- Department of Surgery, Gastroenterological Center, University Medical Center, Yokohama, Japan
| | - Shogo Takei
- Department of Surgery, Gastroenterological Center, University Medical Center, Yokohama, Japan
| | - Yusuke Suwa
- Department of Surgery, Gastroenterological Center, University Medical Center, Yokohama, Japan
| | - Hirokazu Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Mitsuyoshi Ota
- Department of Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, University Medical Center, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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19
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Elias AW, Merchea A, Moncrief S, Wise KB, Colibaseanu DT, Dozois EJ, Mathis KL. Recurrence and Long-Term Survival Following Segmental Colectomy for Right-Sided Colon Cancer in 813 Patients: a Single-Institution Study. J Gastrointest Surg 2020; 24:1648-1654. [PMID: 31270720 DOI: 10.1007/s11605-019-04271-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 05/17/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy exists regarding optimal surgical approach to right-sided colon cancer due to increasing complete mesocolic excision outcome data; yet, scarce long-term surgical and oncologic outcome data from high-volume centers following right segmental resections without complete mesocolic excision make comparisons difficult to interpret. We report long-term outcomes following standard mesocolic excision for right-sided colon adenocarcinoma. METHODS A retrospective review of a prospective database was conducted of all consecutive adult patients undergoing surgery for a right-sided colon adenocarcinoma between 2000 and 2007. Demographics, oncologic, operative, and pathologic details are reported. Primary endpoints consisted of overall survival and recurrence. Patients with stage IV and recurrent disease were excluded. RESULTS Eight hundred thirteen patients were identified. Majority of tumors were stage II (n = 318, 39%). Adjuvant chemotherapy was administered to 228 patients (28%). Recurrence was observed in 97 patients (12%), at median 1.3 years. Recurrence was most commonly distant (n = 73, 9%). At median follow-up 7.3 years, 5- and 10-year overall survival was 72.4%, and 48.6%, respectively. Five- and 10-year disease-free survival was 67% and 45.8%, respectively. Multivariable analysis demonstrated that TNM stage was a significant predictor of recurrence. For disease-free survival, T stage, and N stage were significant on multivariate analysis. Multivariable predictors of overall survival included age, number of lymph nodes removed, N stage, and adjuvant chemotherapy use. CONCLUSIONS Excellent long-term outcomes from a large cohort of patients with non-metastatic, right colon adenocarcinoma treated by segmental colectomy without complete mesocolic excision are reported. The majority of recurrences were distant.
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Affiliation(s)
| | - Amit Merchea
- Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Sara Moncrief
- Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin B Wise
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Eric J Dozois
- Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellie L Mathis
- Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN, USA. .,Division of Colon & Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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20
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Kataoka K, Beppu N, Shiozawa M, Ikeda M, Tomita N, Kobayashi H, Sugihara K, Ceelen W. Colorectal cancer treated by resection and extended lymphadenectomy: patterns of spread in left- and right-sided tumours. Br J Surg 2020; 107:1070-1078. [PMID: 32246469 DOI: 10.1002/bjs.11517] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/26/2019] [Accepted: 01/06/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether tumour side affects the anatomical extent and distribution of lymph node metastasis in colon cancer is unknown. The impact of tumour side on the anatomical pattern of lymphatic spread in colon cancer was assessed. METHODS Patients with stage III colon cancer from a Japanese multi-institutional database who underwent extensive (D3) lymphadenectomy, which is similar in concept to complete mesocolic excision with central venous ligation, were divided into groups with right- and left-sided tumours. Based on location, mesenteric lymph nodes were categorized as paracolic (L1), intermediate (L2) or central (L3). The Kaplan-Meier method was used to evaluate disease-free survival (DFS) and overall survival (OS), and multivariable Cox models were used to evaluate the association between anatomical lymph node level, metastatic pattern and outcome. RESULTS A total of 4034 patients with stage III colon cancer (right 1618, left 2416) were included. Unadjusted OS was worse in patients with right colon cancer (hazard ratio 1·23, 95 per cent c.i. 1·08 to 1·40; P = 0·002), but DFS was similar. Right-sided tumours more frequently invaded L3 nodes than left-sided lesions (8·5 versus 3·7 per cent; P < 0·001). The proportion of patients with a skipped pattern of lymphatic spread was higher in right than in left colon cancer (13·7 versus 9·0 per cent; P < 0·001). In multivariable analysis, invasion of L3 nodes was associated with worse OS in left but not in right colon cancer. The presence of skipped metastasis was associated with worse DFS in left, but not right, colon cancer. CONCLUSION There are significant differences in the pattern of lymph node invasion between right- and left-sided stage III colon cancer, and in their prognostic significance, suggesting that tumour side may dictate the operative approach.
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Affiliation(s)
- K Kataoka
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - N Beppu
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - M Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, Kanagawa, Japan
| | - M Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - N Tomita
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - H Kobayashi
- Department of Surgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - K Sugihara
- Tokyo Medical and Dental University, Tokyo, Japan
| | - W Ceelen
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
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21
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Sammour T, Malakorn S, Thampy R, Kaur H, Bednarski BK, Messick CA, Taggart M, Chang GJ, You YN. Selective central vascular ligation (D3 lymphadenectomy) in patients undergoing minimally invasive complete mesocolic excision for colon cancer: optimizing the risk-benefit equation. Colorectal Dis 2020; 22:53-61. [PMID: 31356721 DOI: 10.1111/codi.14794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/07/2019] [Indexed: 12/16/2022]
Abstract
AIM Complete mesocolic excision (CME) with central vascular ligation (CVL) has been advocated for right colon adenocarcinoma (RC), but the radicality of vascular dissection remains controversial. Our aim is to report outcomes of selective CVL (D3 lymphadenectomy) during minimally invasive CME for RC. METHOD A prospective database identified patients who were treated for RC between 2009 and 2016. Minimally invasive CME was standard. The radicality of lymphadenectomy was defined as high ligation (HL) versus CVL based on operative reports and videos. Two blinded radiologists independently evaluated the pre- and postoperative CT scans for radiographically abnormal nodes. RESULTS Of 197 patients who underwent CME, HL was performed in 56 (28%) and CVL in 141 (72%). There were no baseline differences in age, sex, body mass index, American Society of Anesthesiologists score or pathological staging, and there were no major intra-operative complications in either group (including no major vascular injuries). The median total number of nodes retrieved was 27 and 31 (P = 0.011) in HL and CVL groups, resepctively, with pathologically positive nodes identified in 33.9% and 39.8% (P = 0.704), respectively. Preoperative imaging identified abnormal cN3 nodes in 1.5% of patients; all of whom underwent CVL. No abnormal cN2 or cN3 nodes remained on postoperative imaging. The 60-day mortality was 0.5%, and major morbidity was 4%. One patient (0.5%) had an anastomotic recurrence after a median follow-up of 22 months. CONCLUSION With imperfect preoperative clinical nodal staging, and in the absence of randomized data, the low morbidity and oncological outcomes observed support the approach of CME with HL as a minimum standard, with CVL (D3 lymphadenectomy) in selected cases.
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Affiliation(s)
- T Sammour
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S Malakorn
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - R Thampy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - H Kaur
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B K Bednarski
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C A Messick
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - M Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y N You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Lee SY, Yeom SS, Kim CH, Kim YJ, Kim HR. Distribution of lymph node metastasis and the extent of lymph node dissection in descending colon cancer patients. ANZ J Surg 2019; 89:E373-E378. [PMID: 31452333 DOI: 10.1111/ans.15400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The optimal extent of lymph node dissection in patients with descending colon cancer is still debatable. We designed this study to evaluate the distribution of lymph node metastasis and the appropriate extent of lymph node dissection in descending colon cancer patients. METHODS We retrospectively reviewed the medical records of 118 descending colon cancer patients without distant metastasis, who underwent curative resection between January 2004 and December 2014. The distribution of lymph node metastasis was evaluated, and prognostic factors were analysed. RESULTS The median follow-up period was 52 months (range 1-125 months). Twenty-six (22.0%) patients underwent high ligation of the inferior mesenteric artery (IMA), whereas 92 (78.0%) patients underwent ligation of the left colic artery, saving the IMA. Lymph nodes at the origin of the IMA showed no metastasis in any of the 26 patients who underwent high ligation of the IMA. After propensity score matching, 3-year disease-free survival (80.4% versus 92.9%, P = 0.471) and 5-year overall survival (81.8% versus 90.9%, P = 0.875) were not significantly different according to the type of IMA ligation. CONCLUSION In patients with descending colon cancer, there was no lymph node metastasis at the origin of the IMA, and ligation of the IMA showed no prognostic benefit.
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Affiliation(s)
- Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Seung-Seop Yeom
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
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23
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Kim HJ, Choi GS. Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives. Ann Coloproctol 2019; 35:109-117. [PMID: 31288500 PMCID: PMC6625771 DOI: 10.3393/ac.2019.06.12] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.
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Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Kataoka K, Ysebaert H, Shiozawa M, Reynders D, Ikeda M, Tomita N, Goetghebeur E, Ceelen W. Prognostic significance of number versus location of positive mesenteric nodes in stage iii colon cancer. Eur J Surg Oncol 2019; 45:1862-1869. [PMID: 31153766 DOI: 10.1016/j.ejso.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/29/2019] [Accepted: 05/20/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Debate persists on the ideal extent of lymphadenectomy for colon cancer (CC). Specifically, it is unknown whether the anatomical location of positive lymph nodes (LN) has any independent prognostic significance. We assessed the prognostic value of positive LN location in stage III CC patients who underwent extensive (D3) lymphadenectomy. METHODS Patients from Kanagawa Cancer Center, Japan, who underwent D3 dissection for CC from 2000 to 16 were analyzed. Mesenteric LN were classified according to location as paracolic (L1), intermediate (L2), or central (L3). Recurrence-free survival (RFS) and the corresponding hazard function were evaluated with their trends over the L groups. Multivariate Cox models were used to evaluate the association of LN location with RFS. RESULTS Four hundred forty-six stage III patients were analyzed. The mean number of examined/positive nodes per patient was 42.5/2.6 in L1 (n = 310), 40.9/4.8 in L2 (n = 111), and 44.0/9.8 in L3 (n = 25). RFS was worse for L3 vs. L2 (HR: 2.00, 95%CI [1.05-3.75], p = 0.034) and for L3 vs. L1 (2.62 [1.45-4.71], p = 0.001), but not significantly different between L2 and L1 (1.32 [0.89-1.5], p = 0.17). In a multivariate model adjusting for age, tumor size, and number of lymph nodes harvested T-stage (p < 0.001), adjuvant therapy (p < 0.0038), lymphatic invasion (p = 0.023), and LNR (p = 0.038) were significantly associated with RFS, but not L level or tumor location. CONCLUSION The anatomical location of invaded LN does not significantly correlate with RFS in CC, after adjusting for potential confounders. Central LN are infrequently invaded and confer a worse RFS.
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Affiliation(s)
- Kozo Kataoka
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan; Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan.
| | - Hannes Ysebaert
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Japan
| | - Dries Reynders
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Masataka Ikeda
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan
| | - Naohiro Tomita
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Japan
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Belgium
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Huang Q, Liu E, Hu H, Zhang Q, Zhang Y, Jin Y, Wang M, Wang GY. Prognostic Significance of D3 Lymph Node for Survival in Patients With Colorectal Cancer. J Surg Res 2019; 239:156-165. [PMID: 30831457 DOI: 10.1016/j.jss.2019.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The aim of this study was to investigate the prognostic value of D3 lymph node (TSLN) for the survival of patients with colorectal cancer. METHODS A total of 156 patients with R0 resected colorectal cancer were selected from 2011 to 2015 to carry out a retrospective study. The survival rate according to the groups of positive lymph node number (N: 1-3, N2: 4-6, N3: ≥7) and TSLN (TSLN [-], TSLN [+]) was analyzed. The influences of covariates on the 5-year overall survival (OS) and 5-year disease-free survival (DFS) were determined by the Cox proportional risk model of backward stepwise analysis. Kaplan-Meier survival analysis was used to draw survival curves between and within groups. RESULTS During the median follow-up period (44.0 months), the 5-year DFS rate and OS rate were 45.0% and 46.0%, respectively. Survival analysis of the TSLN group showed that the 5-year OS rate and 5-year DFS rate in the TSLN (+) group (20.0 and 16.2%, respectively) were significantly lower than those in the TSLN (-) group (68.3 and 51.6%, respectively) (P < 0.001). The 5-year OS rate and DFS rate of the TSLN (+) and TSLN (-) subgroups in the N1 group were 16.7%, 33.3%, 56.7%, and 55.7%, respectively (P < 0.001). Multivariate analysis showed that positive lymph node, TSLN, and Pathological T stage were independent prognostic factors of DFS and OS for 5 years. Patients in the TSLN (+) group had a poorer prognosis. CONCLUSIONS TSLN metastasis is an independent factor influencing the prognosis of patients, and patients with TSLN (+) have a poor prognosis. As an independent prognostic factor, this factor should be considered when evaluating the prognosis of patients.
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Affiliation(s)
- Quanlong Huang
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Enrui Liu
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hanqing Hu
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qian Zhang
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yukun Zhang
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yinghu Jin
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meng Wang
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gui-Yu Wang
- Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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26
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Lee SY, Kim DW, Kang SI, Ihn MH, Oh HK, Kang SB, Kim CH, Kim HR, Kim YJ, Ju JK. Impact of Family History on Prognosis of Patients with Sporadic Colorectal Cancer. Ann Surg Oncol 2019; 26:1118-1126. [DOI: 10.1245/s10434-019-07179-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 02/06/2023]
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Willaert W, Cosyns S, Ceelen W. Biology-Based Surgery: The Extent of Lymphadenectomy in Cancer of the Colon. Eur Surg Res 2018; 59:371-379. [DOI: 10.1159/000494831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022]
Abstract
The progression of colon cancer (CC) involves hematogenous and lymphatic spread to locoregional lymph nodes (LN), distant LN, and metastatic sites including the liver. The biological mechanisms that govern CC progression remain elusive. The Halsted model assumes an orderly, stepwise progression from the primary tumor to nearby nodes, henceforth to anatomically more distant nodes, and ultimately to distant organs. The Fisher model, on the other hand, regards the release of metastatic cells as early and essentially random events. The underlying biology has important implications for the ideal extent of surgery: when the Fisher model is correct, efforts to remove apical (central), extramesenteric, or para-aortic LN are unlikely to affect the oncological outcome. Recent data from phylogenetic studies suggest that cancer cell populations differ genetically among different LN stations and from distant metastases. Circulating tumor cells and other liquid biomarkers can be detected in the circulation of patients with early-stage disease. Local recurrence in CC is uncommon, and it is associated with a high risk of systemic progression and poor survival. Clinical studies comparing standard colectomy with extensive surgery (high ligation of the inferior mesenteric artery, complete mesocolic excision, D3 dissection, and para-aortic or extramesenteric node dissection) show that these techniques increase the LN count, while any beneficial effect on the risk of local recurrence or disease-free survival is at present uncertain due to the lack of controlled trials. Ongoing randomized trials comparing extensive vs. standard surgery for CC will generate important answers.
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28
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Tuktagulov NV, Sushkov OI, Muratov II, Shahmatov DG, Nazarov IV. D2 VS D3 LYMPH NODE DISSECTION FOR RIGHT COLON CANCER (review). ACTA ACUST UNITED AC 2018. [DOI: 10.33878/2073-7556-2018-0-3-84-93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wang K, Xiao H, Zhang J, Zhu D. Synaptotagmin7 Is Overexpressed In Colorectal Cancer And Regulates Colorectal Cancer Cell Proliferation. J Cancer 2018; 9:2349-2356. [PMID: 30026831 PMCID: PMC6036711 DOI: 10.7150/jca.25098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/01/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose: Synaptotagmin7 (SYT7) belongs to the synaptotagmin gene family and plays an important role in synaptic transmission. However, the function of this gene in most human cancer especially in colorectal cancer (CRC) remains unknown. In this research, we examined SYT7's role in CRC and tried to reveal its underlying mechanism. Methods: We examined SYT7's expression levels in normal colorectal tissue and CRC tissues from 83 patients and analyzed the possible correlation between the expression level of SYT7 and pathological characteristics. The influences of SYT7 knockdown on cell growth were detected by Celigo image cytometer, colony formation assay, cell cycle analysis and apoptosis assay in vitro. The possible molecular mechanism was assessed using a microarray and Ingenuity Pathway Analysis. Results: Our results show that the expression of SYT7 is upregulated in colorectal cancer tissues in comparison with normal tissues and positively correlated with the pathological stage of colorectal cancer. (P=0.015). We examined SYT7's role in human colorectal cancer cell line RKO by using SYT7-shRNA and revealed that SYT7 knockdown inhibit cell proliferation (P=8.6E-5), clonogenic ability (P=4.5E-6) and promoted G2/M Phase arrest and apoptosis (P=4.6E-7). Multiple cancer-associated pathways regulated by SYT7 were unraveled by microarray and Ingenuity Pathway Analysis. Conclusions: Our study suggests that SYT7 plays an important role in the development of CRC and SYT7 may become a new therapeutic target in CRC.
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Affiliation(s)
- Kewei Wang
- Department of Gastrointestinal & hernia Surgery, First Hospital of China Medical University, Shenyang, China
| | - Huimin Xiao
- Department of General Surgery, People's Hospital of China Medical University, Shenyang, China
| | - Jiaqi Zhang
- Department of Gastrointestinal & hernia Surgery, First Hospital of China Medical University, Shenyang, China
| | - Dehua Zhu
- Department of Gastrointestinal & hernia Surgery, First Hospital of China Medical University, Shenyang, China
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30
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Lee SY, Kim CH, Kim YJ, Kim HR. Prognostic significance of the distribution of lymph node metastasis in rectal cancer after neoadjuvant chemoradiation. J Surg Oncol 2017; 117:514-522. [DOI: 10.1002/jso.24871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/09/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Soo Young Lee
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
| | - Chang Hyun Kim
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
| | - Young Jin Kim
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
| | - Hyeong Rok Kim
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
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31
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Chen Y, Liu F, Meng Q, Ma S. Is neuroendocrine differentiation a prognostic factor in poorly differentiated colorectal cancer? World J Surg Oncol 2017; 15:71. [PMID: 28351413 PMCID: PMC5370452 DOI: 10.1186/s12957-017-1139-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background To determine the prognostic relevance of neuroendocrine differentiation in poorly differentiated colorectal cancer. Methods The clinicopathological features and survival of 70 patients with poorly differentiated colorectal cancer were analyzed retrospectively. Chromogranin A and synaptophysin were used as neuroendocrine markers. Patients were followed-up for more than 3 years or until death. Results Of these 70 patients, 36 showed neuroendocrine differentiation. In univariate prognostic analysis, the patients with lymph node metastasis (P < 0.001), advanced TNM stage (P < 0.001), and neuroendocrine differentiation (P = 0.003) tended to have a poor prognosis. However, only lymph node metastasis was associated with a poor prognosis in multivariate analysis (P < 0.001). Patients with neuroendocrine differentiation were associated with lymph node metastasis (P = 0.006). Conclusions Neuroendocrine differentiation in poorly differentiated colorectal cancer was not a direct prognostic factor in these patients. Lymph node metastasis was a direct prognostic factor in these patients. Patients with neuroendocrine differentiation were associated with lymph node metastasis.
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Affiliation(s)
- Yue Chen
- Department of colorectal surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Fang Liu
- Department of colorectal surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China.
| | - Qingkai Meng
- Department of colorectal surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Siping Ma
- Department of colorectal surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
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Pattern of Colon Cancer Lymph Node Metastases in Patients Undergoing Central Mesocolic Lymph Node Excision: A Systematic Review. Dis Colon Rectum 2016; 59:1209-1221. [PMID: 27824707 DOI: 10.1097/dcr.0000000000000658] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Extended mesocolic lymph node dissection in colon cancer surgery seems to improve oncological outcome. A possible reason might be related to metastases in the central mesocolic lymph nodes. OBJECTIVE The purpose of this study was to describe the pattern of mesocolic lymph node metastases, particularly in central lymph nodes, and the risk of skip, aberrant, and gastrocolic ligament metastases as the argument for performing extended lymph node dissection. DATA SOURCES EMBASE and PubMed were searched using the terms colon or colorectal with sentinel node, lymph node mapping, or skip node; lymph node resection colon; and complete or total and mesocolic excision. STUDY SELECTION Studies describing the risk of metastases in central, skip, aberrant, and gastrocolic ligament lymph node metastases from colon adenocarcinomas in 10 or more patients were included. No languages were excluded. MAIN OUTCOME MEASURES The risk of metastases in the central mesocolic lymph nodes was measured. RESULTS A total of 2052 articles were screened, of which 277 underwent full-text review. The 47 studies fulfilling the inclusion criteria were very heterogeneous, and meta-analyses were not considered appropriate. The risk of central mesocolic lymph node metastases for right-sided cancers varies between 1% and 22%. In sigmoid cancer, the risk is reported in ≤12% of the patients and is associated with advanced T stage. LIMITATIONS The retrospective design and heterogeneity, in terms of definitions of lymph node location, tumor sites, stage, morphology, pathology assessment, and inclusion criteria (selection bias), of the included studies were limitations. Also, anatomic definitions were not uniform. CONCLUSIONS The present literature cannot give a theoretical explanation of a better oncological outcome after extended lymph node dissection. Consensus for a standardization of anatomical definitions and surgical and pathological assessments is warranted for future mapping studies.
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Bao F, Zhao LY, Balde AI, Liu H, Yan J, Li TT, Chen H, Li GX. Prognostic impact of lymph node skip metastasis in Stage III colorectal cancer. Colorectal Dis 2016; 18:O322-O329. [PMID: 27438774 DOI: 10.1111/codi.13465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/29/2016] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to evaluate the prognostic impact of lymph node skip metastasis (LNSM) in patients with Stage III colorectal cancer. METHOD Between April 2003 and December 2014, a total of 41 patients with lymph node skip metastasis (skip+) were compared with 86 patients with pericolic lymph node metastases [lymph node distribution (LND)1] and 57 patients with intermediate and/or main lymph node metastasis (LND2+3). All patients had radical D3 lymphadenectomy, performed either laparoscopically or as open surgery. RESULTS The frequency of pT1-2 stage cancer was significantly higher in the skip+ group than in the LND1 group (26.8% vs 5.8%, P = 0.001). The number of metastatic lymph nodes in the skip+ group was lower than in the LND2+3 group (1.9 ± 1.5 vs 6.5 ± 6.0, P < 0.001). The 3-year disease-free survival (DFS) of the skip+, LND1 and LND2+3 groups was 64.8%, 69.7% and 40.1%, respectively (P = 0.008). The 3-year systemic recurrence rates of the skip+, LND1 and LND2+3 groups were 30.2%, 20.3% and 48.1%, respectively; (P = 0.002). Cox regression analysis revealed that preoperative carcinoembryonic antigen (CEA) of ≥ 5 ng/ml [hazard ratio (HR) = 2.2, P = 0.029], poor differentiation (HR = 3.8, P = 0.001) and skip+ (HR = 0.2, P = 0.021) were independently prognostic factors for DFS. CONCLUSION The prognosis for the LND1-negative lymph node skip metastasis group was better than for the LND2+3 group and was comparable with that of the LND1 group after radical D3 lymphadenectomy.
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Affiliation(s)
- F Bao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of General Surgery, Mianyang Central Hospital, Mianyang, China
| | - L-Y Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - A I Balde
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - H Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - J Yan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - T-T Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - H Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - G-X Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wang Q, Chen E, Cai Y, Chen C, Jin W, Zheng Z, Jin Y, Chen Y, Zhang X, Li Q. Preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by using carbon nanoparticles in laparoscopy. World J Surg Oncol 2016; 14:231. [PMID: 27577559 PMCID: PMC5004270 DOI: 10.1186/s12957-016-0987-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Background The objective of this study is to evaluate the effectiveness of preoperative endoscopic localization of colorectal cancer and tracing lymph nodes by carbon nanoparticle tattooing in laparoscopic colorectal cancer surgery. Methods From January 2013 to December 2014, 54 patients with colorectal cancer were recruited and divided into experimental (n = 27) and control (n = 27) groups. The patients in the experimental group were localized preoperatively by endoscopic carbon nanoparticle tattooing, whereas patients in the control group were not tattooed. Results All injection sites in the experimental group were visible to surgeons. No abdominal pain, fever, diarrhea, and other symptoms of infection were found in the experimental group. The time for detecting the tumor (2.71 ± 2.13 min versus 6.91 ± 5.16 min, p < 0.001), operation time (151.22 ± 30.66 min versus 170.26 ± 33.13 min, p = 0.033), and blood loss during the operation (125.04 ± 29.48 mL versus 147.52 ± 34.35 mL, p = 0.013) were lower in the experimental group than in the control group. Average numbers of dissected lymph nodes in the experimental group exceeded those in the control group (14.41 ± 3.32 versus 8.96 ± 2.90, p < 0.001), and the rate of dissected lymph nodes ≥12 was higher in the experimental group than in the control group (70.37 versus 37.04 %, p < 0.001). Moreover, no difference in postoperative complications was found between the two groups. Conclusions Tattooing colorectal cancer with carbon nanoparticles in laparoscopic colorectal cancer surgery is safe and useful both in localization and lymph node tracing.
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Affiliation(s)
- Qingxuan Wang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Endong Chen
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yefeng Cai
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Chong Chen
- Department of General Surgery, Pingyang People's Hospital, Wenzhou, Zhejiang Province, 325000, China
| | - Wenxu Jin
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Zhouci Zheng
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yixiang Jin
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Yao Chen
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Xiaohua Zhang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China.
| | - Quan Li
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China.
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Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, Arai M, Ueno M. Prognostic Impact of Distribution of Lymph Node Metastases in Stage III Colon Cancer. World J Surg 2016; 39:3008-15. [PMID: 26304607 DOI: 10.1007/s00268-015-3190-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) with central vascular ligation (CVL) is a well-known concept in colon cancer surgery. However, data on the oncological benefits of CVL are scarce. The objective of this study was to evaluate the prognostic significance of the distribution of lymph node metastases (LND) in patients with stage III colon cancer who underwent CME with CVL. METHODS In total, 446 consecutive patients who underwent curative resection for stage III colon cancer from 2005 to 2011 were analyzed. Patients were classified as having LND1 (metastases in pericolic nodes), LND2 (metastases in intermediate nodes), or LND3 (metastases in main nodes). Survival outcomes were compared among the three groups. RESULTS LND1, LND2, and LND3 were identified in 299 (67.0 %), 122 (27.4 %), and 25 (5.6 %) patients, respectively. The 5-year overall survival and relapse-free survival (RFS) of all patients were 86.7 and 76.2 %, respectively. The 5-year RFS of patients with LND1, LND2, and LND3 were 82.8, 65.4, and 52.0 %, respectively (p < 0.0001). Multivariate analysis showed that LND2 was an independent prognostic factor for RFS (p = 0.0185), although the significance of LND3 was marginal (p = 0.0621). Among patients with pN1, the 5-year RFS of patients with LND1 and LND2+3 were significantly different (84.4 vs. 71.5 %, respectively, p = 0.0102), and similar tendency was found between patients with pN2-LND1 and pN2-LND2+3 (72.6 vs. 53.1 %, p = 0.0428). CONCLUSION The high 5-year survival rates of patients with stage III colon cancer, even those with LND2 and LND3, would justify CVL as the standard procedure for advanced colon cancer.
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Affiliation(s)
- Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yoshiya Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masami Arai
- Department of Clinical Genetic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Kim CH, Lee SY, Kim HR, Kim YJ. Pathologic stage following preoperative chemoradiotherapy underestimates the risk of developing distant metastasis in rectal cancer: A comparison to staging without preoperative chemoradiotherapy. J Surg Oncol 2016; 113:692-9. [PMID: 26914147 DOI: 10.1002/jso.24207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/06/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES There is still little evidence of a relationship between pathologic stage with or without preoperative chemoradiotherapy (CRT) in rectal cancer. The aim of this study was to investigate the prognostic implication of the preoperative-CRT pathologic stage (ypStage) by comparing it to the pathologic stage without preoperative-CRT (pStage). METHODS Between July 2004 and December 2012, 774 consecutive patients who received radical surgery for histologically diagnosed rectal adenocarcinoma (clinical stage I-III) were included. RESULTS A total of 674 surviving patients were followed-up for a median of 43.4 months. Five-year local recurrence (LR) -free survival rates were similar for each ypStage and the corresponding pStage. In contrast, 5-year distant metastasis (DM) -free survival rates were poorer for each ypStage than for the corresponding pStage. The hazard ratio increased with a decrease in pathological stages (Stage I: 3.5, Stage II: 2.2, and Stage III: 1.4). CONCLUSIONS ypStage in rectal cancer is a good prognostic factor in predicting LR and DM. Although the ypStage can stratify patients according to the risk of developing DM, the risk as determined by the ypStage could be higher than that of corresponding pStage, especially in patients showing a higher degree of downstaging. J. Surg. Oncol. 2016;113:692-699. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
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Secernin-1 contributes to colon cancer progression through enhancing matrix metalloproteinase-2/9 exocytosis. DISEASE MARKERS 2015; 2015:230703. [PMID: 25814779 PMCID: PMC4357136 DOI: 10.1155/2015/230703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/14/2015] [Indexed: 01/01/2023]
Abstract
Emerging evidence shows that exocytosis plays a key role in tumor development and metastasis. Secernin-1 (SCRN1) is a novel regulator of exocytosis. Our previous work identified SCRN1 as a tumor-associated gene by bioinformatics analysis of transcriptomes. In this study, we demonstrated the aberrant overexpression of SCRN1 at mRNA and protein level in colon cancer. We also revealed that overexpression of SCRN1 was significantly associated with the tumor development and poor prognosis. Experiments in vitro validated that SCRN1 may promote cancer cell proliferation and secretion of matrix metalloproteinase-2/9 (MMP-2/9) proteins to accelerate tumor progression.
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Clinicopathologic features and oncologic outcomes of colorectal cancer patients with extremely high carcinoembryonic antigen. Int J Colorectal Dis 2015; 30:63-9. [PMID: 25367182 DOI: 10.1007/s00384-014-2053-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study is to investigate the clinicopathologic features and oncologic outcomes of colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative serum carcinoembryonic antigen (CEA) levels. METHODS We enrolled 756 primary colorectal cancer patients with elevated preoperative CEA levels (≥5 ng/mL) who underwent surgery between 2004 and 2010 and compared clinicopathologic features according to preoperative CEA levels of 5-50 ng/mL (n = 676) and ≥50 ng/mL (n = 80). The impact of extremely elevated CEA on overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS The median follow-up period was 43 months (range, 0-121). Patients with preoperative CEA ≥50 ng/mL demonstrated higher rates of advanced T stage (97.3 vs. 88.6%, p = 0.016) and distant metastasis (33.8 vs. 17.9%, p = 0.002), but not lymph node metastasis (54.1 vs. 52.2%, p = 0.807). The 5-year OS rate was 69.1%, and the 3-year DFS rate of curatively resected patients (n = 641; 84.8%) was 68.9%. In multivariate analysis, preoperative CEA ≥50 ng/mL, as well as age, N stage, vascular invasion, perineural invasion, post/preoperative CEA ratio ≥0.32, and palliative resection, was an independent predictor of OS. However, for patients treated with curative resection, preoperative CEA ≥50 ng/mL was not significantly associated with DFS or OS (p = 0.053 and 0.157, respectively). CONCLUSIONS Colorectal cancer patients with extremely elevated (≥50 ng/mL) preoperative CEA had advanced disease more frequently but comparable oncologic outcomes if curative resection was performed.
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