Extended Lymphadenectomy in Colon Cancer is Crucial

Abstract

No one doubts that lymph node dissection in colon cancer is necessary, it is just the extent of that dissection that is still under debate. As the individual steps of an oncologic operation cannot be separated from each other, analysis of the significance of lymph node dissection alone is difficult. It has been proven that the T category is directly related to the number and central spread of lymph node metastases. Micrometastases and isolated tumor cells may be detected in lymph nodes by using special staining techniques; their presence may worsen prognosis significantly and approximate it to UICC stage III. The numbers of dissected lymph nodes and the ratio of involved versus dissected lymph nodes have been used as markers for quality of surgery and histopathological evaluation. Recent results underscore the importance of technique and extent of dissection. Dissection must be performed along the embryologic planes of the mesocolon and leave them intact. A high vascular tie with preservation of the central hypogastric nerves must be applied in order to achieve the best oncologic results while preserving quality of life. Extended lymphadenectomy is oncologically relevant only when it is combined with removal of the primary tumor with adequate longitudinal clearance, an intact complete mesocolon, and high vascular tie. It is part of a concept in which the tumor-bearing specimen is harvested as an enveloped package to minimize the risk of tumor cell spillage and local recurrence.

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

“…High‐tie ligation has been advocated1, 2, 3, 4, 5, 6 because it allows more radical resection and more accurate pathological staging. Others7, 8, 9, 10, 11, 12, 13 favour low‐tie ligation because of increased blood flow to the proximal end of the anastomosis.…”

Totally robotic right hemicolectomy with the hanging technique for carcinoid tumour – a video vignette

“…A complete cure is usually possible in cases diagnosed and treated early. Extensive lymph node dissection is crucial for colon cancer surgery . To this end, various techniques have been proposed to achieve better oncological results.…”

“…To this end, various techniques have been proposed to achieve better oncological results. Complete mesocolic excision is a surgical technique involving high ligation of the vessels and extensive resection of the colonic mesentery and lymph nodes within it . Furthermore, the early isolation and division of mesenteric vessels is a technique employed in order to prevent the venous spread of tumour cells while performing mobilization of the specimen during resection .…”

The choice of optimal lymph node dissection extent in surgical treatment for colon cancer: protocol the clinical trial

“…Кроме того, было показано, что удаление 28 и более ЛУ ассоции-ровано с увеличением выживаемости у пациентов с N0 [9]. Выполнение СМЕ способствует удалению практи-чески всех лимфогенных метастазов [10]. Нарушение фасциального футляра при СМЕ, напротив, ведет к ухудшению выживаемости [11,12].…”