Optimal extent of central lymphadenectomy for right-sided colon cancers: is lymphadenectomy beyond the superior mesenteric vein meaningful?

Sahara, Kota; Watanabe, Jun; Ishibe, Atsushi; Goto, Kazumi; Takei, Shogo; Suwa, Yusuke; Suwa, Hirokazu; Ota, Mitsuyoshi; Kunisaki, Chikara; Endo, Itaru

doi:10.1007/s00595-020-02084-6

Cited by 14 publications

(6 citation statements)

References 27 publications

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“…There have been reports on the long‐term outcomes in Japanese patients who have undergone D3 dissection 22,23 . However, in Japan, D3 dissection of right‐sided colon cancer has traditionally been limited to the area around the SMV.…”

Section: Discussionmentioning

confidence: 99%

“…There have been reports on the long-term outcomes in Japanese patients who have undergone D3 dissection. 22,23 However, in Japan, D3 dissection of right-sided colon cancer has traditionally been limited to the area around the SMV. The importance of dissecting pathologically positive main lymph nodes, including when D3 dissection is performed around the SMA, is controversial in terms of survival and recurrence.…”

Section: Along Two Arteriesmentioning

confidence: 99%

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A multicenter prospective observational study of lymph node metastasis patterns and short‐term outcomes of extended lymphadenectomy in right‐sided colon cancer

Tsukamoto

Ouchi

Kono

et al. 2023

Annals of Gastroent Surgery

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BackgroundThe 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.MethodsThis 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.ResultsBetween 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%).ConclusionRoutine 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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Section: Discussionmentioning

confidence: 99%

Section: Along Two Arteriesmentioning

confidence: 99%

A multicenter prospective observational study of lymph node metastasis patterns and short‐term outcomes of extended lymphadenectomy in right‐sided colon cancer

Tsukamoto

Ouchi

Kono

et al. 2023

Annals of Gastroent Surgery

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“…The present study focused on TI as a promising index with proven implications in gastric cancer, where the efficacy of lymph node dissection is well established 16,23 . The significance of TI has been demonstrated more recently for various gastrointestinal cancers, including colorectal cancer, esophageal cancer, and pancreatic cancer 24‐27 . Sahara et al 28 reported on the significance of TI for ICC, and identified which patients would benefit from lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

“… 16 , 23 The significance of TI has been demonstrated more recently for various gastrointestinal cancers, including colorectal cancer, esophageal cancer, and pancreatic cancer. 24 , 25 , 26 , 27 Sahara et al 28 reported on the significance of TI for ICC, and identified which patients would benefit from lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

Clinical implications and optimal extent of lymphadenectomy for intrahepatic cholangiocarcinoma: A multicenter analysis of the therapeutic index

Umeda

Takagi

Matsuda³

et al. 2022

Annals of Gastroent Surgery

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Aims Lymph node metastases (LNM) are associated with lethal prognosis in intrahepatic cholangiocarcinoma (ICC). Lymphadenectomy is crucial for accurate staging and hopes of possible oncological treatment. However, the therapeutic implications and optimal extent of lymphadenectomy remain contentious. Methods To clarify the prognostic value and optimal extent of lymphadenectomy, the therapeutic index (TI) for each lymph node was analyzed for 279 cases that had undergone lymphadenectomy in a multi‐institutional database. Tumor localization was divided into hilar lesions (n = 130), right peripheral lesions (n = 60), and left peripheral lesions (n = 89). In addition, the lymph node station was classified as Level 1 (LV1: hepatoduodenal ligament node), Level 2 (LV2: postpancreatic or common hepatic artery nodes), or Level 3 (LV3: gastrocardiac, left gastric artery, or celiac artery nodes). Results Lymph node metastases were confirmed in 109 patients (39%). Five‐y survival rates were 45.3% for N0 disease, 27.1% for LV1‐LNM, 22.9% for LV2‐LNM, and 7.3% for LV3‐LNM ( P < 0.001). LV3‐LNM were the most frequent and earliest recurrence outcome, including multisite recurrence, followed by LV2, LV1, and N0 disease. The 5‐year TI (5year‐TI) for lymphadenectomy was 7.2 for LV1, 5.5 for LV2, and 1.9 for LV3. Regarding tumor location, hilar lesions showed 5‐year TI >5.0 in LV1 and LV2, whereas bilateral peripheral lesions showed 5‐year TI > 5.0 in LV1. Conclusion The implications and extent of lymphadenectomy for ICC appear to rely on tumor location. In the peripheral type, the benefit of lymphadenectomy would be limited and dissection beyond LV1 should be avoided, while in the hilar type, lymphadenectomy up to LV2 could be recommended.

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“…[3,6] Extended lymphadenectomy for proximal transverse colon cancer, which also includes excision of the gastrocolic ligament, has proven advantages, but there are also complications associated with this technique. [7][8][9] Among the complications that can occur are: delayed gastric emptying (DGE), chronic diarrhea, chronic abdominal pain, postoperative pancreatitis. [10][11][12] DGE with consecutive pulmonary aspiration and anastomotic leaks seem to have increased since the introduction of extended lymphadenectomy.…”

Section: Introductionmentioning

confidence: 99%

Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial

Popescu,

Leopa,

Iordache

et al. 2023

Medicine

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Background: Delayed gastric emptying sometimes occurs after right colectomy with extended lymphadenectomy. The aim of this randomized controlled trial is to evaluate the effect on delayed gastric emptying after performing a fixation of the stomach to the retrogastric tissue to return the stomach to a physiological position after right colectomy with lymphadenectomy, including gastrocolic lymph nodes dissection for proximal transverse colon cancer. Methods: From January 2015 to December 2020, patients undergoing right colectomy with extensive lymphadenectomy for proximal transverse colon cancer were randomly assigned to either the gastropexy group or the conventional group. In the gastropexy group, the posterior wall of the stomach, at the level of the antrum, was sutured to the retrogastric tissue to prevent the abnormal shape that the gastric antrum acquires together with the duodeno-pancreatic complex, the shape that leads to an obstruction of the antrum region and to the delay in emptying the gastric contents. Results: Mean age, sex, comorbidities, and right colectomy procedures were similar in the 2 groups. Delayed gastric emptying developed in twelve patients in the conventional group (38.7%) versus 4 patients (12.1%) in the gastropexy group (P = .014). The total number of complications was higher in the conventional group (14 complications) than in the gastropexy group (7 complications). According to univariate analysis, gastropexy significantly lowered the risk of delayed gastric emptying (P = .014). Overall morbidity was 9.7% in the conventional group versus none in the gastropexy group. Postoperative hospitalization was longer in the conventional group (7.61 ± 3.26 days) than in the gastropexy group (6.24 ± 1.3 days; P = .006). Conclusion: Gastropexy decreases the occurrence of delayed gastric emptying after right colectomy with extended lymphadenectomy for proximal transverse colon cancer.

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Optimal extent of central lymphadenectomy for right-sided colon cancers: is lymphadenectomy beyond the superior mesenteric vein meaningful?

Cited by 14 publications

References 27 publications

A multicenter prospective observational study of lymph node metastasis patterns and short‐term outcomes of extended lymphadenectomy in right‐sided colon cancer

A multicenter prospective observational study of lymph node metastasis patterns and short‐term outcomes of extended lymphadenectomy in right‐sided colon cancer

Clinical implications and optimal extent of lymphadenectomy for intrahepatic cholangiocarcinoma: A multicenter analysis of the therapeutic index

Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial

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