Postoperative Quality Assessment Score Can Select Patients with High Risk for Locoregional Recurrence in Colon Cancer

Livadaru, Cristian; Moscalu, Mihaela; Ghitun, Florina Adriana; Huluta, Alexandra Ramona; Terinte, Cristina; Ferariu, Dan; Luncă, Sorinel; Dimofte, Gabriel

doi:10.3390/diagnostics12020363

Cited by 4 publications

(2 citation statements)

References 66 publications

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“…3 A further factor in this equation is the quality of the surgery performed; this has improved substantially throughout the past decade. 141516,28,29 The consequence of the improved surgery seems to be a reduction in the number of widespread recurrences, as seen earlier. 30 It is possible that having a clear definition of the central lymph nodes (D3 volume) allows for the complete removal of these nodes in most patients, thus reducing the incidence of recurrence in them.…”

Section: Discussionmentioning

confidence: 67%

Comparing 5-Year Survival Rates Before and After Re-stratification of Stage I–III Right-Sided Colon Cancer Patients by Establishing the Presence/Absence of Occult Tumor Cells and Lymph Node Metastases in the Different Levels of Surgical Dissection

Banipal

Štimec²,

Andersen³

et al. 2022

Journal of Gastrointestinal Surgery

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Background To establish the impact of re-stratification on the outcomes of patients (stage I–III right-sided colon cancer) based on the presence/absence of occult tumor cells (OTC) and/or metastatic lymph nodes in the different levels of surgical dissection. Methods Consecutive patients were drawn from a multicenter prospective trial. After surgery, the surgical specimen was divided into the D1/D2 and D3 volumes before being further analyzed separately. All lymph nodes were examined with cytokeratin CAM 5.2 immunohistochemically. Lymph nodes containing metastases and OTC (micrometastases; isolated tumor cells) were identified. Re-stratification was as follows: RS1, stages I/II, no OTC in D1/D2 and D3 volumes; RS2, stages I/II, OTC in D1/D2 and/or D3; RS3, stage III, lymph node metastases in D1/D2, with/without OTC in D3; RS4, stage III, lymph node metastases in D3, with/without OTC in D3. Results Eighty-seven patients (39 men, 68.4 + 9.9 years) were included. The standard stratified (SS) group contained the following: stages I/II (SS1) 57 patients; stage III (SS2) 30 patients. Re-stratified (RS) contained RS1 (38), RS2 (19), RS3 (24), and RS4 (6) patients. Lymph node ratio (OTC) RS2: 0.157 D1/D2; 0.035 D3 and 0.092 complete specimens. Lymph node ratio RS3: 0.113 D1/D2; complete specimen 0.056. Overall survival and disease-free survival were p = 0.875 and p = 0.049 for SS and p = 0.144 and p = 0.001 for RS groups, respectively. Conclusion This re-stratification identifies a patient group with poor prognosis (RS4). Removing this group from SS2 eliminates all the differences in survival between RS2 and RS3 groups. The level of dissection of the affected nodes may have an impact on survival. Clinical Trial “Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-Detector Computed Tomography (MDCT) Angiography” registered at http://clinicaltrials.gov/ct2/show/NCT01351714

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Section: Discussionmentioning

confidence: 67%

Comparing 5-Year Survival Rates Before and After Re-stratification of Stage I–III Right-Sided Colon Cancer Patients by Establishing the Presence/Absence of Occult Tumor Cells and Lymph Node Metastases in the Different Levels of Surgical Dissection

Banipal

Štimec²,

Andersen³

et al. 2022

Journal of Gastrointestinal Surgery

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“…To assess whether MAF ultrastaging increases total LN yield compared with standard pathological examination, we compared the LN count in patients who underwent ultrastadialization (MAF group) with patients who underwent standard pathological staging without MAF extraction (control group). The data for the control group were extracted from the databases in two of our previous publications [18,19].…”

Section: Comparison Of Lymph Node Yieldmentioning

confidence: 99%

The mesocolic apical fragment in complete mesocolic excision colectomies: Should it be analysed separately? A proof‐of‐concept study

et al. 2022

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Aim:The aim of this work is to describe a protocol and assess the feasibility of harvesting and analysing the mesocolic apical fragment (MAF) for the presence of central lymph node (LN) metastasis and extra lymphatic free tumour cells in a random subgroup extracted from a cohort of complete mesocolic excision colectomies with central vascular ligation.Method: Forty-seven patients diagnosed with colorectal cancer were included. A 2/2 cm pyramid of tissue was cut around the central tie and sent for pathological examination.The MAF was sectioned into 16 slices. High-definition images were taken from the slices which were merged into a panoramic three-dimensional image of the MAF. The distribution of LNs in the MAF was quantified. Immunohistochemistry staining for cytokeratin 14 was used to identify isolated tumour cells and micrometastases in the extranodal tissue. Results:No tumoural cells migrating through the apical zone, outside of the LNs, were identified. Margins of resection, mesocolic tissue and LNs were all negative in the subgroup of ultrastaged MAFs. The number of examined central LNs varied between 0 and 24, with positive MAF LNs being identified only in pN2 stages. The rate of positive apical LNs in our cohort was 4.2% (n = 2). Conclusions:The MAF can be easily extracted from standard specimens, allowing for accurate analysis of lymphatic and extra-nodal tumour cells on the central resection margins, in central LNs and in the apical mesocolic tissue. Future research on larger cohorts is required to establish if analysing the MAF has an impact on patient staging, prognosis and management.

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Computed tomography in quality control of surgery for right colon cancer

Kholeva,

Agababian,

Nevolskikh

et al. 2024

Koloproktologiâ

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AIM: to assess the length of the stump of the feeding arteries of the right colon, their anatomical location relative to the superior mesenteric vein (SMV), the level of ligation of the main arteries after right hemicolectomy with D2- and D3-lymphadenectomy. PATIENTS AND METHODS: the retrospective study included 82 patients with a histologically confirmed right colon cancer aged 44-88 (mean 68) years. All patients underwent right hemicolectomy. In 40 cases, D2 lymph node dissection was performed, in 42 cases — in D3. Preoperatively, all patients were assessed for the location of the ileocolic and right colon arteries relative to the SMV and the expected length of their stumps was measured by CT. Postoperatively, the actual length of the stumps was assessed. RESULTS: CT images of the ileocolic artery stump were obtained in 76 (92.6%) of 82 patients. In 6 patients, a metal clips were installed along the contour of the superior mesenteric artery; in such cases, a clear CT image of the stump of the ileocolic artery was not obtained, and the length of the stump was assessed as 0 mm. The stump of the right colic artery was determined in all patients in whom the artery was identified preoperatively. The ventral location of the ileocolic artery relative to the SMV according to CT data was identified in 38 (46.3 %) of 82 patients, the dorsal location — in 44 (53.7 %) of 82 patients. With the ventral location of the ileocolic artery relative to the SMV in patients with D2, the length of the artery was 14.3 (8-25.6) mm, with D3 — 7.6 (3.3–11.1) mm (p = 0.005). With the dorsal location of the ileocolic artery relative to the SMV in patients with D2, the length of the artery was 8.8 (4.9–16.2) mm, with D3 — 3.9 (1–6.9) mm (p = 0.004). CONCLUSION: the actual length of the stump of the feeding artery can become an indicator of the level of ligation of the main arteries and, indirectly, the extent of lymphadenectomy after right hemicolectomy. Further studies with a larger number of cases are needed to confirm the hypothesis for measuring the length of the stump of the feeding arteries as a marker of the extent of the procedure performed.

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Postoperative Quality Assessment Score Can Select Patients with High Risk for Locoregional Recurrence in Colon Cancer

Cited by 4 publications

References 66 publications

Comparing 5-Year Survival Rates Before and After Re-stratification of Stage I–III Right-Sided Colon Cancer Patients by Establishing the Presence/Absence of Occult Tumor Cells and Lymph Node Metastases in the Different Levels of Surgical Dissection

Comparing 5-Year Survival Rates Before and After Re-stratification of Stage I–III Right-Sided Colon Cancer Patients by Establishing the Presence/Absence of Occult Tumor Cells and Lymph Node Metastases in the Different Levels of Surgical Dissection

The mesocolic apical fragment in complete mesocolic excision colectomies: Should it be analysed separately? A proof‐of‐concept study

Computed tomography in quality control of surgery for right colon cancer

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