Prognostic significance of location of lymph node metastases in colorectal cancer

Shida, Haruhiko; Ban, Kanako; Matsumoto, Masao; Masuda, Kozo; Imanari, Tomohiro; Machida, Takehisa; Yamamoto, Takashi

doi:10.1007/bf02252994

Cited by 64 publications

(36 citation statements)

References 14 publications

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“…Up to now, there have been few reports on skipping nodal metastases. Shida et al (10) reported that 12 of 38 n2 patients with colon cancer had skipping nodal metastases and that there was no significant difference between skip+ and skipin 5 year disease-free survival. In this study, we showed that 10.4% of colon cancer patients and 11.0% of rectal cancer patients with nodal metastases had skipping nodal metastases.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that the number of nodal metastases may have strong predictive value and this subclassification of nodal status is used in the TNM classification (2). On the other hand, some authors have reported that the location of lymph node metastases, rather than the number, is the most important prognostic factor in colorectal cancer patients (10). In general, when tumor cells begin to metastasize to lymph nodes, they usually metastasize toward the node of origin of the tumor feeding artery and the location of nodes with metastasis is a marker of staging in colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological Characteristics of Skipping Lymph Node Metastases in Patients with Colorectal Cancer

Yamamoto

Takahashi

Yasuno

et al. 1998

Japanese Journal of Clinical Oncology

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Background:We have sometimes experienced cases of colorectal cancer with skipping lymph node metastasis in whichdistantnodeswerepositive butthosecloserto the tumor were negative. There have been few reports of this condition and its clinical characteristics have not been clarified. This study was conducted to clarify the status of skipping lymph node metastasis and its clinicopathological characteristics in colorectal cancer. Methods: We analyzed 452patients withcolorectal cancerand nodal metastases (270withcolon cancer and 182 with rectal cancer). All the resected nodes were examined using histological procedures with a microscope andwere classified by theirlocation according to the GeneralRules for Clinical and Pathological Studies on Cancerof the Colon, Rectum and Anus. We studied the status of skipping nodalstatusand the correlation between the nodalstatus and clinicopathological findings, including the disease-free survival, depth of tumor, histological type, staging and recurrence. Results: Twenty-eight (10.4 %) of the colon cancer patients and 20 (11.0%) of the rectal cancer patients were found to have skipping nodal metastases. In rectal cancer patients with n2 (nodal metastases at the N2 site) in the direction of the main node, patients with skipping lymph node metastases had a significantly betterprognosis than thosewithout(p = 0.026). In all colon cancer patients and rectal cancerpatients with lateral n3 (nodal metastases at the lateral N3 site), there were a tendency for those with skipping nodal metastases to have better disease-free survival rates (p =0.1).Also, the meannumberof positive nodesin skipping caseswas significantly lower than that in non-skipping cases. Inaddition, skipping nodal metastases in rectal cancersuggested a possibility of bypass flow which was not generally recognized. Conclusion: These findings in colorectal cancer suggest the presence of previously unknown lymphatic tracts and that the cancers concerned have a better prognosis than those without skipping nodal metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinicopathological Characteristics of Skipping Lymph Node Metastases in Patients with Colorectal Cancer

Yamamoto

Takahashi

Yasuno

et al. 1998

Japanese Journal of Clinical Oncology

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“…This issue could be relevant, because location of PN was demonstrated to be an independent variable associated with survival in many series. [14][15][16][17][18] Moreover, the only series reporting survival according to this current version failed to show any difference between N1 and N2 subcategories. 19 These findings question whether the current categorization of Stage III is appropriate.…”

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confidence: 96%

Colorectal Cancer Staging: Reappraisal of N/PN Classification

Vaccaro¹,

Bonadeo²,

Benati³

et al. 2004

Diseases of the Colon &Amp; Rectum

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“…However, there have not been any definitive conclusions and various opinions have been expressed around the world. On the other hand, the impact of upward lymph node dissection for sigmoid colon or upper rectal carcinoma has been discussed in several reports [5,6,7], and yet few studies have focused on this issue in advanced lower rectal carcinoma. Although Pezim et al[ 8] reported that high ligation of the inferior mesenteric artery had no survival advantage for rectal carcinoma patients, no counterarguments have been published and it remains difficult to generalize about the impact of upward lymph node dissection.…”

Section: Introductionmentioning

confidence: 99%

Impact of Upward Lymph Node Dissection on Survival Rates in Advanced Lower Rectal Carcinoma

et al. 2007

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Background/Aims: This study investigated appropriate level of upward lymph node (LN) dissection in advanced lower rectal carcinoma. Methods: A total of 285 consecutive patients with stage II/III lower rectal carcinoma were analyzed. LN dissection was classified as follows: division of the root of the superior rectal artery (UD2), division of the root of the inferior mesenteric artery (UD3) and UD3 with para-aortic LN dissection (UD4). Results: LN metastases at the root of the inferior mesenteric artery were found in 4 patients. Their prognoses were worse than those of the other stage III patients (p = 0.011). On the other hand, LN metastases along the superior rectal artery were discovered in 14 patients, whose 5-year overall survival rate was 61.2%. By removing the LNs either UD2 or UD3/4, a similar survival rate was achieved in stage III patients with LN metastases along the superior rectal artery. Conclusion: Survival of a minority with metastatic LNs at the root of the inferior mesenteric artery was poor. Additionally, survival is no worse in patients with positive LN along the superior rectal artery as long as these positive nodes are resected by either UD2 or UD3/4. Low ligation is adequate for advanced lower rectal carcinoma.

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Prognostic significance of location of lymph node metastases in colorectal cancer

Cited by 64 publications

References 14 publications

Clinicopathological Characteristics of Skipping Lymph Node Metastases in Patients with Colorectal Cancer

Clinicopathological Characteristics of Skipping Lymph Node Metastases in Patients with Colorectal Cancer

Colorectal Cancer Staging: Reappraisal of N/PN Classification

Impact of Upward Lymph Node Dissection on Survival Rates in Advanced Lower Rectal Carcinoma

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