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Naidu K, Chapuis P, Yang J, Koneru S, Chan C, Rickard M, Ng KS. Is computed tomography assessment of residual arterial pedicle length following colorectal cancer surgery a useful marker of surgical quality? Tech Coloproctol 2025; 29:101. [PMID: 40220058 PMCID: PMC11993473 DOI: 10.1007/s10151-025-03130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/23/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND In vivo residual arterial pedicle length (RAPL) has been proposed as a quality indicator for central vascular ligation (CVL [i.e., RAPL ≤ 10 mm]) in colorectal cancer (CRC) surgery. However, its survival association in non-routine CVL practice requires clarification. This study aimed to assess the feasibility and reproducibility of measuring RAPL alongside its oncological associations in non-routine CVL surgery. METHODS A prospective cohort study at Concord Hospital was conducted on anterior resection (AR) or right hemicolectomy (RH) patients with stage I to III CRC (1995-2019). Using surveillance computed tomography (CT), RAPL of the inferior mesenteric artery (IMA) or ileo-colic artery (ICA) pedicle was measured independently by two observers. The intra-class correlation coefficient assessed the reproducibility of the measurements. Kaplan-Meier and univariate Cox regression analyses estimated overall survival (OS) and disease-free survival (DFS), while univariate and multivariate linear regression models tested correlations between RAPL and clinicopathological features. RESULTS A total of 1425 patients underwent a CRC operation. Post-operative CTs were reviewed in 424 patients, with 422 (mean age 69.0 years [SD 12.3]; 54.0% males) RAPLs measured. The majority studied underwent an AR (59.2%). Excellent inter-rater reliability was noted in AR (ICC = 0.97; P < 0.001) and RH (ICC = 0.89; P < 0.001) patients. No association was observed between RAPL and OS or DFS in either group. Also, RAPL lacked association with nodal harvest in either AR (P = 0.54) or RH (P = 0.16) patients. CONCLUSION The value of RAPL as a quality marker of CRC surgery in non-routine CVL practice has not been confirmed. Furthermore, its lack of association with nodal harvest emphasizes the importance and the need for comprehensive pathology examination of the specimen following resection of CRC.
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Affiliation(s)
- K Naidu
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia
| | - P Chapuis
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia
| | - J Yang
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia
- Department of Radiology, Concord Hospital, Concord, NSW, 2139, Australia
| | - S Koneru
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia
| | - C Chan
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia
- Department of Anatomical Pathology, Concord Hospital, Concord, NSW, 2139, Australia
| | - M Rickard
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia
| | - K-S Ng
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia.
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia.
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Concord, NSW, 2139, Australia.
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Xu L, Wang J, Peng Y, Wu C, Wang S, Zhang X, Liang C, Wan S, Yang C, Fu Q, Xia Y, Huang X, Xu L. Clinical comparative study of the modified superior mesenteric artery approach in total laparoscopic radical resection for right colon cancer - a single-center retrospective study. World J Surg Oncol 2025; 23:67. [PMID: 40016739 PMCID: PMC11869699 DOI: 10.1186/s12957-025-03725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 02/21/2025] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND To explore the safety and feasibility of the modified approach for accessing the superior mesenteric artery (SMA) in total laparoscopic radical resection for right colon cancer. METHODS This single-center retrospective study included 107 patients who underwent total laparoscopic radical resection of right colon cancer at The First Affiliated Hospital of Wannan Medical College between August 2022 and December 2023. 53 patients were in the modified SMA approach (modified group) and 54 patients were in the traditional SMA approach (control group). The control group and modified group underwent total laparoscopic radical resection of right colon cancer, and the following baseline and pathological characteristics of the two groups were compared: intraoperative condition, postoperative recovery, and postoperative complications. Our modified surgical method was to isolate the mesocolon using a cranial(the ligament of Treitz) -to- caudal(the pedicle of ileocolic) pathway and the orderly ligation of blood vessels in the SMA. RESULTS There was no statistically significant difference in the baseline characteristics or pathological data between the two groups. Compared with the traditional SMA approach, the modified SMA approach had a shorter surgical time(P < 0.001) and vascular dissection time (P < 0.001) and less intraoperative blood loss (P = 0.000). There was no statistically significant difference in the number of total harvested lymph nodes or positive harvested lymph nodes between the two groups of patients (P > 0.05); There was no statistically significant difference in postoperative hospital stay, time to first flatus, time to pull out drainage tube and drainage between the two groups of patients (P > 0.05), and there was no statistically significant difference in the incidence of complications between the two groups of patients (P > 0.05). CONCLUSION The modified SMA approach in totally laparoscopic radical resection for right colon cancer can shorten the surgical and vascular dissection time, reduce intraoperative bleeding and reduce the surgical difficulty and intraoperative risk of the SMA approach for right colon cancer. In clinical practice, its safety and feasibility are relatively high, and it is worth promoting. TRIAL REGISTRATION The study was approved by the Ethics Committee of The First Affiliated Hospital of Wannan Medical College and registered with the China Clinical Trials Registry (ChiCTR2300075919, Date of Registration:2023-09-19- retrospective registration) http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Lishuai Xu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Jiawei Wang
- Department of General Surgery, Maanshan Maternal and Child Health Care Hospital, No.446 Jiashan Road, Ma'anshan, Anhui, 243000, China
| | - Yue Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Chengwei Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Song Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Xu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Changming Liang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Senlin Wan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Cheng Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Qingsheng Fu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Yabin Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China
| | - Xiaoxu Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China.
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China.
| | - Li Xu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, No.2, Zheshan West Road, Wuhu, Anhui, Anhui, 241001, China.
- Anhui Province Key Laboratory of Non-Coding RNA Basic and Clinical Transformation, Wuhu, Anhui, China.
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Jongsma WA, Grüter AAJ, Toorenvliet BR, Tuynman JB, Tanis PJ. Comment on the Definition and Interpretation of Complete Mesocolic Excision in the RELARC Trial. J Clin Oncol 2025; 43:763-764. [PMID: 39661935 DOI: 10.1200/jco-24-02228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 10/16/2024] [Indexed: 12/13/2024] Open
Affiliation(s)
- Willemijn A Jongsma
- Willemijn A. Jongsma, MD, and Alexander A.J. Grüter, MD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Boudewijn R. Toorenvliet, MD, PhD, Ikazia Hospital, Department of Surgery, Rotterdam, the Netherlands; Jurriaan B. Tuynman, MD, PhD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; and Pieter J. Tanis, MD, PhD, Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Alexander A J Grüter
- Willemijn A. Jongsma, MD, and Alexander A.J. Grüter, MD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Boudewijn R. Toorenvliet, MD, PhD, Ikazia Hospital, Department of Surgery, Rotterdam, the Netherlands; Jurriaan B. Tuynman, MD, PhD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; and Pieter J. Tanis, MD, PhD, Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Boudewijn R Toorenvliet
- Willemijn A. Jongsma, MD, and Alexander A.J. Grüter, MD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Boudewijn R. Toorenvliet, MD, PhD, Ikazia Hospital, Department of Surgery, Rotterdam, the Netherlands; Jurriaan B. Tuynman, MD, PhD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; and Pieter J. Tanis, MD, PhD, Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Jurriaan B Tuynman
- Willemijn A. Jongsma, MD, and Alexander A.J. Grüter, MD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Boudewijn R. Toorenvliet, MD, PhD, Ikazia Hospital, Department of Surgery, Rotterdam, the Netherlands; Jurriaan B. Tuynman, MD, PhD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; and Pieter J. Tanis, MD, PhD, Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Pieter J Tanis
- Willemijn A. Jongsma, MD, and Alexander A.J. Grüter, MD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Boudewijn R. Toorenvliet, MD, PhD, Ikazia Hospital, Department of Surgery, Rotterdam, the Netherlands; Jurriaan B. Tuynman, MD, PhD, Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; and Pieter J. Tanis, MD, PhD, Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands, Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
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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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Raje P, Sonal S, Kunitake H, Berger DL, Lee GC, Ricciardi R, Morita S, Shigeta K, Okabayashi K, Goldstone RN. Comparison of conventional resection to D3 lymphadenectomy in right-sided colon cancer: A retrospective cohort study. Am J Surg 2024; 237:115911. [PMID: 39178599 DOI: 10.1016/j.amjsurg.2024.115911] [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: 07/06/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Lymphadenectomy during right hemicolectomy for colon cancer varies between the U.S. and Japan. METHODS Patients undergoing right hemicolectomy for non-metastatic right-sided colon cancer between 2010 and 2019 at U.S. and Japanese institutions were compared. Outcomes included survival, pathologic findings, and postoperative complications. RESULTS 319 American patients (57 % female, mean age 70 years) underwent conventional resection and 308 Japanese patients (52 % female, mean age 70 years) underwent extended dissection. The conventional group underwent more laparotomies (26.6 % vs. 8.4 %, p < 0.001), had more poorly differentiated histology (31.7 % vs. 11.0 %, p < 0.01), lower lymph node yield (M = 27 ± 11 vs. M = 32 ± 14, p < 0.001), and more 30-day readmissions (31 vs. 5, p < 0.001). Adjusting for demographics, pathology, perioperative outcomes, and adjuvant chemotherapy, extended lymphadenectomy improved disease-free survival (HR 0.50; 95 % CI, 0.31-0.80; p = 0.004), but not overall survival (HR 0.98; 95 % CI, 0.95-1.02; p = 0.14). CONCLUSIONS Extended lymphadenectomy for right sided-colon cancer improves disease-free, but not overall, survival among Japanese patients.
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Affiliation(s)
- Praachi Raje
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Swati Sonal
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - David L Berger
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Grace C Lee
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Rocco Ricciardi
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Satoru Morita
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Shigeta
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Robert N Goldstone
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Naidu K, Chapuis PH, Chan C, Rickard MJFX, West NP, Jayne DG, Ng KS. Tissue morphometric measurements do not predict survival following colorectal cancer surgery. World J Surg Oncol 2024; 22:216. [PMID: 39174976 PMCID: PMC11340191 DOI: 10.1186/s12957-024-03496-1] [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: 07/07/2024] [Accepted: 08/10/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Ex vivo tissue morphometric (TM) measurements have been proposed as a quality marker for colorectal cancer (CRC) surgery. However, their survival associations require clarification. This study aimed to evaluate the feasibility of capturing TM measurements based on ex vivo fresh specimen images and explore the association between these TM measurements and survival outcomes. METHODS A prospective cohort study at Concord Hospital, Sydney was conducted with Stage I to III CRC patients (2009-2019) who underwent an anterior resection (AR) or right hemicolectomy (RH). Using high-resolution digital photographs of fresh CRC specimens, ex vivo tissue morphometric (TM) measurements-resected mesentery area (TM A), distances from high vascular tie to tumour (TM B) and bowel wall (TM C), and bowel length (TM D)-were recorded using Image J. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan-Meier and Cox regression analyses. Linear regression models tested association between TM measurements and lymph node (LN) yield. RESULTS Of the 1,425 patients who underwent CRC surgery, TM measurements were performed on 312 patients, with an average age of 69.4 years (SD 12.3), of whom 52.9% were male. The majority had an AR (57.8%). Among AR patients, a 5-year OS rate of 77.4% and a DFS rate of 70.1% were observed, with TM measurements bearing no relationship to survival outcomes. Similarly, RH patients exhibited a 5-year OS rate of 67.2% and a DFS rate of 63.1%, with TM measurements again showing no association with survival. Only TM D (P = 0.02) measurements were associated with the number of LNs examined. CONCLUSION This study successfully demonstrates the feasibility of measuring TM measurements on photographs of ex vivo fresh specimens following CRC surgery. The lack of association with survival outcomes questions the utility of TM measurements as a quality metric of CRC surgery.
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Affiliation(s)
- Krishanth Naidu
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia
| | - Pierre H Chapuis
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia
| | - Charles Chan
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia
- Department of Anatomical Pathology, Concord Hospital, Concord, NSW, 2139, Australia
| | - Matthew J F X Rickard
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia
| | - Nicholas P West
- Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - David G Jayne
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK
- Academic Surgery, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Kheng-Seong Ng
- Colorectal Surgery Unit, Concord Hospital, Concord, NSW, 2139, Australia.
- Concord Institute of Academic Surgery, Concord Hospital, Building 20, Level 1, Hospital Road, Concord, NSW, 2139, Australia.
- Concord Clinical School, Clinical Sciences Building, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia.
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Seow-En I, Villanueva ME, Eu EW, Tan EJKW. Laparoscopic D3 right hemicolectomy with intracorporeal anastomosis. Tech Coloproctol 2024; 28:92. [PMID: 39093328 DOI: 10.1007/s10151-024-02965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/22/2024] [Indexed: 08/04/2024]
Abstract
Complete mesocolic excision (CME) with D3 lymphadenectomy for colon cancer has been shown to improve overall as well as disease-free survival compared to conventional right hemicolectomy. Performing a laparoscopic CME/D3 right hemicolectomy with intracorporeal anastomosis (ICA) can be technically demanding even for experienced operators. Here, we present a systematic, standardized approach to the surgery.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, 169608, Singapore.
| | - Maureen Elvira Villanueva
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, 169608, Singapore
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines , Manila, Philippines
| | - Ernest Wencong Eu
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, 169608, Singapore
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Nevolskikh AA, Avdeenko VA, Reznik IP, Pochuev TP, Zibirov RF, Ivanov SA, Kaprin AD. Surgical treatment of right colon cancer. SIBERIAN JOURNAL OF ONCOLOGY 2024; 23:133-149. [DOI: 10.21294/1814-4861-2024-23-3-133-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The study aimed to perform a systematic review of the literature on surgical treatment for right colon cancer (RCC) with complete mesocolic excision (CME) and D2/D3 lymph node dissection (LND). Material and Methods. A literature review was performed for studies published between 2013 and 2023 by the online resources from the official Web sites of the societies/panels and PubMed database. Sources included guidelines, meta-analyses, randomized and nonrandomized clinical studies, guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network, Russian clinical guidelines. Results. CME significantly improved both immediate and long-term treatment results, which was confirmed by numerous meta-analyses. The extent of LND remains one of the most controversial issues in RCC. For many Asian surgeons, D3 LND is the standard procedure for the treatment of RCC, whereas the European approach is more conservative and apical lymph node dissection is not mandatory. There are also large differences in understanding the extent of D3 LND in RCC. Most surgeons understand this term as dissection of adipose tissue along the anterior and lateral surface of the superior mesenteric vein, however, there are authors who perform circular dissection along the superior mesenteric vessels, considering this extent of surgery to be the most radical. Conclusion. It is necessary to standardize methods and effective criteria for quality control of CME for RCC and LND. In this case, external independent assessment of the quality of surgical intervention is important. There is also currently a growing number of studies in which intraoperative fluorescence imaging makes it possible to better visualize the location of the apical lymph nodes and individualize LND.
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Affiliation(s)
- A. A. Nevolskikh
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia
| | - V. A. Avdeenko
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia
| | - I. P. Reznik
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia
| | - T. P. Pochuev
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia
| | - R. F. Zibirov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia
| | - S. A. Ivanov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia;
RUDN University
| | - A. D. Kaprin
- RUDN University;
P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia;
National Medical Research Radiological Centre of the Ministry of Health of the Russia
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9
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Yıldırım M, Kocabay A, Koca B, Saglam AI, Ozkan N. The effect of ileal resection length on postoperative complications and prognosis in right colon cancer. Langenbecks Arch Surg 2024; 409:206. [PMID: 38967821 PMCID: PMC11226531 DOI: 10.1007/s00423-024-03395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND There is a lack of literature on the length of the terminal ileum to be resected in right hemicolectomy for colon cancer. Therefore, we aimed to determine the mean ileal loop length and the effect of this variation on postoperative complications and long-term oncological outcomes in patients who underwent right hemicolectomy. METHODS Right hemicolectomy surgeries performed for colon cancer in a tertiary care hospital between January 2011 and December 2018 were retrospectively analyzed from a prospective database. Two patient groups were established based on the mean length of the resected ileum above and below 7 cm. The two groups were compared for clinicopathological data, postoperative complications, mortality, long-term overall survival (OS) and disease-free survival (DFS). The factors contributing to OS and DFS were analyzed. RESULTS The study included 217 patients. Body mass index (BMI) values were significantly higher in the ileum resection length > 7 cm group (p = 0.009). Pathological N stage, tumor diameter, and number of metastatic lymph nodes were significantly higher in the ileum resection length > 7 cm group (p = 0.001, p = 0.001, and p = 0.026, respectively). There was no significant difference for postoperative complication and mortality rates between the two groups. The mean follow-up period was 61.2 months (2-120) in all patients. The total number of deaths was 29 (11.7%) while the 60-month OS was 83.5% and 50-month DFS was 81.8%. There was no significant difference between the groups in terms of OS and DFS rates (p > 0.05). CONCLUSIONS Excessive resection of the distal ileum in right hemicolectomy does not provide any benefit in terms of prognosis and complications.The ileum resection length and values close to it in our study appear to be sufficient.
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Affiliation(s)
- Murat Yıldırım
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey.
| | - Asım Kocabay
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
| | - Bulent Koca
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
| | - Ali Ihsan Saglam
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
| | - Namık Ozkan
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
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10
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Aiolfi A, Bona D, Rausa E, Manara M, Biondi A, Basile F, Campanelli G, Kelly ME, Bonitta G, Bonavina L. Effect of complete mesocolic excision (cme) on long-term survival after right colectomy for cancer: multivariate meta-analysis and restricted mean survival time estimation. Langenbecks Arch Surg 2024; 409:80. [PMID: 38429427 DOI: 10.1007/s00423-024-03273-4] [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: 11/22/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Debate exists concerning the impact of complete mesocolic excision (CME) on long-term oncological outcomes. The aim of this review was to condense the updated literature and assess the effect of CME on long-term survival after right colectomy for cancer. METHODS PubMed, MEDLINE, Scopus, and Web of Science were searched through July 2023. The included studies evaluated the effect of CME on survival. The primary outcome was long-term overall survival. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. GRADE methodology was used to summarize the certainty of evidence. RESULTS Ten studies (3665 patients) were included. Overall, 1443 (39.4%) underwent CME. The RMSTD analysis shows that at 60-month follow-up, stage I-III CME patients lived 2.5 months (95% CI 1.1-4.1) more on average compared with noCME patients. Similarly, stage III patients that underwent CME lived longer compared to noCME patients at 55-month follow-up (6.1 months; 95% CI 3.4-8.5). The time-dependent HRs analysis for CME vs. noCME (stage I-III disease) shows a higher mortality hazard in patients with noCME at 6 months (HR 0.46, 95% CI 0.29-0.71), 12 months (HR 0.57, 95% CI 0.43-0.73), and 24 months (HR 0.73, 95% CI 0.57-0.92) up to 27 months. CONCLUSIONS This study suggests that CME is associated with unclear OS benefit in stage I-III disease. Caution is recommended to avoid overestimation of the effect of CME in stage III disease since the marginal benefit of a more extended resection may have been influenced by tumor biology/molecular profile and multimodal adjuvant treatments.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy.
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Emanuele Rausa
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Michele Manara
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, Surgical Division, University of Catania, Catania, Italy
| | - Francesco Basile
- Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, Surgical Division, University of Catania, Catania, Italy
| | - Giampiero Campanelli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | | | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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11
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Kit OI, Gevorkyan YA, Karachun AM, Soldatkina NV, Bondarenko OK, Kolesnikov VE. [D2 and D3 lymph node dissection for colon cancer]. Khirurgiia (Mosk) 2024:25-35. [PMID: 39008695 DOI: 10.17116/hirurgia202407125] [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] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To evaluate surgical and oncological results of standard and extended lymph node dissection (D2 and D3) in patients with colon cancer. MATERIAL AND METHODS We analyzed treatment outcomes in 74 patients with colon cancer stage T1-4aN0-2M0 who underwent right- and left-sided hemicolectomy, resection of sigmoid colon with standard and extended lymph node dissection (D2 and D3). RESULTS Surgical approach and level of D3 lymph node dissection did not increase intra- and postoperative morbidity. Laparoscopic interventions were followed by significantly lower intraoperative blood loss and earlier gas discharge. Metastatic lesion of apical lymph nodes was observed in 5 out of 36 patients who underwent D3 lymph node dissection (13.8%), and metastases in regional lymph nodes rN1-2 were found in all these patients. Overall 5-year survival was 86%. Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection. CONCLUSION D3 lymph node dissection is safe for colon cancer. Metastatic lesions of apical lymph nodes during D3 lymph node dissection were detected only in patients with lesions of regional lymph nodes (rN1-2). Disease-free and overall 5-year survival were similar after D2 and D3 lymph node dissection.
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Affiliation(s)
- O I Kit
- National Medical Research Center of Oncology, Rostov-on-Don, Russia
| | - Yu A Gevorkyan
- National Medical Research Center of Oncology, Rostov-on-Don, Russia
| | - A M Karachun
- Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - N V Soldatkina
- National Medical Research Center of Oncology, Rostov-on-Don, Russia
| | - O K Bondarenko
- National Medical Research Center of Oncology, Rostov-on-Don, Russia
| | - V E Kolesnikov
- National Medical Research Center of Oncology, Rostov-on-Don, Russia
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12
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Wang J, Liu H, Li A, Jiang H, Pan Y, Chen X, Yin L, Lin M. A new membrane anatomy-oriented classification of radical surgery for rectal cancer. Gastroenterol Rep (Oxf) 2023; 11:goad069. [PMID: 38145104 PMCID: PMC10739184 DOI: 10.1093/gastro/goad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/26/2023] Open
Abstract
For patients with different clinical stages of rectal cancer, tailored surgery is urgently needed. Over the past 10 years, our team has conducted numerous anatomical studies and proposed the "four fasciae and three spaces" theory to guide rectal cancer surgery. Enlightened by the anatomical basis of the radical hysterectomy classification system of Querleu and Morrow, we proposed a new classification system of radical surgery for rectal cancer based on membrane anatomy. This system categorizes the surgery into four types (A-D) and incorporates corresponding subtypes based on the preservation of the autonomic nerve. Our surgical classification unifies the pelvic membrane anatomical terminology, validates the feasibility of classifying rectal cancer surgery using the theory of "four fasciae and three spaces," and lays the theoretical groundwork for the future development of unified and standardized classification of radical pelvic tumor surgery.
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Affiliation(s)
- Jiaqi Wang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P. R. China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, P. R. China
| | - Hailong Liu
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P. R. China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, P. R. China
| | - Ajian Li
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Huihong Jiang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P. R. China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, P. R. China
| | - Yun Pan
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, P. R. China
| | - Xin Chen
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, P. R. China
| | - Lu Yin
- Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Moubin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P. R. China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, P. R. China
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13
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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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14
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Grüter AAJ, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study). Tech Coloproctol 2023; 27:1083-1090. [PMID: 37097330 PMCID: PMC10562307 DOI: 10.1007/s10151-023-02801-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. METHODS The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien-Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. DISCUSSION The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. TRIAL REGISTRATION ClinicalTrials.gov: NCT04889456, May 2021.
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Affiliation(s)
- Alexander A J Grüter
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Usha K Coblijn
- Department of Surgery, Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, The Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Surgery, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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15
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Baldari L, Boni L, Cassinotti E. Lymph node mapping with ICG near-infrared fluorescence imaging: technique and results. MINIM INVASIV THER 2023; 32:213-221. [PMID: 37261486 DOI: 10.1080/13645706.2023.2217916] [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: 01/16/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Lymphadenectomy represents a fundamental step during gastrointestinal cancer resection, as the removal of an adequate number of lymph nodes is crucial to define the stage of the disease and prognosis. Lymphadenectomy during gastric and colorectal resection and adrenalectomy for cancer are technically demanding and can be associated with risk of bleeding. To date, lymphadenectomy is often performed without any visual aid. Indocyanine green fluorescence for lymph node mapping can provide better intraoperative visualization. The purpose of this review is to report the current evidence on this topic. MATERIALS AND METHODS A systematic research of the electronic databases Medline, Embase and Google Scholar was conducted from the inception to December 2022. RESULTS This review summarizes the current evidence of techniques and results of fluorescence guided lymphatic mapping during gastrointestinal and adrenal surgery. CONCLUSION According to this review, ICG guided lymphadenectomy for gastrointestinal tumours and adrenocortical carcinoma is feasible and safe. In gastrointestinal tumours it allows higher number of harvested lymph nodes.
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Affiliation(s)
- Ludovica Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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16
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Popescu RC, Leopa N, Iordache IE, Dan C, Moldovan C, Ghioldis AC, Olteanu CM, Kacani A, Cindea I, Popescu I. Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e35255. [PMID: 37746998 PMCID: PMC10519464 DOI: 10.1097/md.0000000000035255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/15/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
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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Affiliation(s)
- Răzvan Cătălin Popescu
- Department of General Surgery, Emergency Hospital of Constanța, Constanța, Romania
- Ovidius University, Faculty of Medicine and Pharmacy Constanta, Constanța, Romania
| | - Nicoleta Leopa
- Department of General Surgery, Emergency Hospital of Constanța, Constanța, Romania
- Ovidius University, Faculty of Medicine and Pharmacy Constanta, Constanța, Romania
| | - Ionut-Eduard Iordache
- Department of General Surgery, Emergency Hospital of Constanța, Constanța, Romania
- Ovidius University, Faculty of Medicine and Pharmacy Constanta, Constanța, Romania
| | - Cristina Dan
- Department of General Surgery, Emergency Hospital of Constanța, Constanța, Romania
| | - Cosmin Moldovan
- Titu Maiorescu University of Bucharest, Faculty of Medicine, Bucharest, Romania
| | - Andrei-Cristian Ghioldis
- Department of General Surgery, Emergency Hospital of Constanța, Constanța, Romania
- Ovidius University, Faculty of Medicine and Pharmacy Constanta, Constanța, Romania
| | | | - Andrea Kacani
- Department of General Surgery, Emergency Hospital of Constanța, Constanța, Romania
| | - Iulia Cindea
- Ovidius University, Faculty of Medicine and Pharmacy Constanta, Constanța, Romania
- Department of Anesthesiology, Emergency Hospital of Constanța, Constanța, Romania
| | - Ioana Popescu
- Ovidius University, Faculty of Medicine and Pharmacy Constanta, Constanța, Romania
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17
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Jarrett R, West NP. Macroscopic Evaluation of Colon Cancer Resection Specimens. Cancers (Basel) 2023; 15:4116. [PMID: 37627144 PMCID: PMC10452811 DOI: 10.3390/cancers15164116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them.
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Affiliation(s)
| | - Nicholas P. West
- Pathology & Data Analytics, Leeds Institute of Medical Research, St. James’s University Hospital, School of Medicine, University of Leeds, Leeds LS9 7TF, UK
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18
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Lygre KB, Eide GE, Forsmo HM, Dicko A, Storli KE, Pfeffer F. Complications after open and laparoscopic right-sided colectomy with central lymphadenectomy for colon cancer: randomized controlled trial. BJS Open 2023; 7:zrad074. [PMID: 37643373 PMCID: PMC10465081 DOI: 10.1093/bjsopen/zrad074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and the fear of major complications. This randomized controlled trial compared the rate of postoperative morbidity in patients undergoing laparoscopic versus open right-sided colectomy with central lymphadenectomy. METHODS This open, prospective, randomized controlled trial compared patients operated on with open and laparoscopic right-sided colectomy (cStages I-III) with a central lymphadenectomy at two Norwegian institutions between October 2016 and December 2021. Dissections were conducted along the superior mesenteric vein in the laparoscopic group, and along the left anterior border of the superior mesenteric artery in the open group, both according to complete mesocolic excision principles. Surgery was standardized and performed by three experienced surgeons for each study group. The primary outcome of interest was to measure postoperative 30-day complications (Clavien-Dindo ≥ grade II). RESULTS Of 273 eligible patients, 135 were randomized and 128 analysed (63 operated on with open and 65 using laparoscopic procedures). Postoperative complications occurred in 42.8 per cent of the patients treated with open and 38.4 per cent of the patients treated using laparoscopic surgery, P = 0.372. The incidence of Clavien-Dindo grade IIIb complications was 7.9 per cent in the open versus 4.6 per cent in the laparoscopic group, P = 0.341. There were no grade IV or V complications, and no re-operations due to anastomotic leakages. There was no significant difference in the mean(s.e.m.) number of removed lymph nodes (open versus laparoscopic respectively: 31.9(1.8) versus 29.3(1.3); P = 0.235). CONCLUSION There was no significant difference in complications between the two groups. Standardized oncologic right-sided colectomy with central lymphadenectomy along the mesenterial root was performed safely, both open and laparoscopic, with incidence of major complications ranging between 4.6 and 7.9 per cent and no re-operations for anastomotic leakage. Radicality in terms of lymphadenectomy was comparable between the two groups.Registration number: NCT03776591 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Kristin B Lygre
- Department of Gastrointestinal Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir E Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Havard M Forsmo
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Aly Dicko
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kristian E Storli
- Department of Gastrointestinal Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frank Pfeffer
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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19
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Naidu K, Chapuis PH, Brown KGM, Chan C, Rickard MJFX, Ng KS. Splenic flexure cancer survival: a 25-year experience and implications for complete mesocolic excision (CME) and central vascular ligation (CVL). ANZ J Surg 2023; 93:1861-1869. [PMID: 36978261 DOI: 10.1111/ans.18434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The management of splenic flexure cancers (SFCs) in the era of complete mesocolic excision (CME) and central vascular ligation (CVL) is challenging because of its variable lymphatic drainage. This study aimed to compare survival outcomes for SFCs and non-SFCs, and better understand the clinicopathological characteristics which may define a distinct SFC phenotype. METHODS An observational cohort study at Concord Hospital, Sydney was conducted with patients who underwent resection for colon adenocarcinoma (1995-2019). Clinicopathological data were extracted from a prospective database. Overall survival (OS) and disease-free survival (DFS) estimates and their associations to clinicopathological variables were investigated with Kaplan-Meier and Cox regression analyses. RESULTS Of 2149 patients with colon cancer, 129 (6%) had an SFC. The overall 5-year OS and DFS rates were 63.6% (95% CI 62.5-64.7) and 59.4% (95% CI 58.3-60.5), respectively. SFCs were not associated with OS (P = 0.6) or DFS (P = 0.5). SFCs were more likely to present urgently (P < 0.001) with obstruction (P < 0.001) or perforation (P = 0.03), and more likely to require an open operation (P < 0.001). These characteristics were associated with poorer survival outcomes. No differences were noted between SFCs and non-SFCs with respect to tumour stage (P = 0.3). CONCLUSION SFCs have a distinct phenotype, the individual characteristics of which are associated with poorer survival. However, the survivals of SFCs and non-SFCs are similar, possibly because the most important determinant of outcome, tumour stage, is no different between the groups. This may have implications for the surgical approach to SFCs with respect to standardization of CME and CVL surgery for these cancers.
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Affiliation(s)
- Krishanth Naidu
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
| | - Pierre H Chapuis
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
| | - Kilian G M Brown
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
| | - Charles Chan
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
- Department of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, 2139, Australia
| | - Matthew J F X Rickard
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
| | - Kheng-Seong Ng
- Colorectal Surgery Unit, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Institute of Academic Surgery, Concord Hospital, Sydney, New South Wales, 2139, Australia
- Concord Clinical School, Clinical Sciences Building, Concord Hospital, University of Sydney, Sydney, New South Wales, 2139, Australia
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20
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Andersen BT, Kazaryan AМ, Stimec BV, Ignjatovic D. The Long Tale of the Famous Herr Toldt and the Less-Known Monsieur Fredet. Dis Colon Rectum 2023; 66:e314. [PMID: 36940297 DOI: 10.1097/dcr.0000000000002868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Bjarte T Andersen
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Airazat М Kazaryan
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway, Institute for Clinical Medicine, University of Oslo, Oslo, Norway, Interventional Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway, Department of Surgery, Fonna Hospital Trust, Odda, Norway, Department of Faculty Surgery N 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia, Department of Surgery N 2, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Bojan V Stimec
- Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dejan Ignjatovic
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway, Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
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21
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Cuk P, Jawhara M, Al-Najami I, Helligsø P, Pedersen AK, Ellebæk MB. Robot-assisted versus laparoscopic short- and long-term outcomes in complete mesocolic excision for right-sided colonic cancer: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:171-181. [PMID: 36001164 DOI: 10.1007/s10151-022-02686-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes. METHODS Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2). RESULTS Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included. CONCLUSIONS This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mohamad Jawhara
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Issam Al-Najami
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
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22
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Yalikun A, Cai Z, Hong HJ, Dai K, Li S, Kwan W, Ma J, Feng B, Lu A, Zheng M, Zang L. Infrapyloric (No. 206) and greater curvature (No. 204) lymph node metastasis in adenocarcinoma located in the right half of the transverse colon (InCLART Study): protocol for a multicentre prospective observational study. BMJ Open 2023; 13:e066981. [PMID: 36810166 PMCID: PMC9944796 DOI: 10.1136/bmjopen-2022-066981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION In the case of right-sided transverse colon cancer (RTCC) and hepatic flexure colon cancer (HFCC), there is a potential connection of lymph drainage between mesentery and greater omentum. However, most previous reports have been limited case series with No. 206 and No. 204 lymph node (LN) dissection for RTCC and HFCC. METHODS AND ANALYSIS The InCLART Study is a prospective observational study aiming to enrol 427 patients with RTCC and HFCC treated at 21 high-volume institutions in China. The prevalence of infrapyloric (No. 206) and greater curvature (No. 204) LN metastasis and short-term outcomes will be investigated in a consecutive series of patients with T2 or deeper invasion RTCC or HFCC, following the principle of complete mesocolic excision with central vascular ligation. Primary endpoints were performed to identify the prevalence of No. 206 and No. 204 LN metastasis. Secondary analyses will be used to estimate prognostic outcomes, intraoperative and postoperative complications, the consistency of preoperative evaluation and postoperative pathological results of LN metastasis. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Ruijin Hospital Ethics Committee (approval number: 2019-081) and has been or will be approved successively by each participating centre's Research Ethics Board. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03936530; https://clinicaltrials.gov/ct2/show/NCT03936530).
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Affiliation(s)
- Abudushalamu Yalikun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Zhenghao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Hi-Ju Hong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Kefan Dai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Wingyan Kwan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Aiguo Lu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medcine, Shanghai, People's Republic of China
- Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China
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23
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Long-term oncologic outcome of D3 lymph node dissection for clinical stage 2/3 right-sided colon cancer. Int J Colorectal Dis 2023; 38:42. [PMID: 36790520 DOI: 10.1007/s00384-023-04310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To investigate oncologic outcomes including overall survival and disease-free survival depending on the extent of lymphadenectomy (D3 versus D2) by comparing D3 and D2 lymphadenectomy in patients with clinical stage 2/3 right colon cancer. METHODS Consecutive series of patients who underwent radical resection for right colon cancer at our three hospitals between January 2015 and June 2018 were retrospectively analyzed. Study cohorts were divided into two groups: D3 group and D2 group. Oncologic, pathologic, and perioperative outcomes of the two groups were compared. RESULTS A total of 295 patients (167 in the D2 group and 128 in the D3 group) were included in this study. Patients' characteristics showed no significant difference between the two groups. The median number of harvested lymph nodes was significantly higher in the D3 group than in the D2 group. The rate of complications was not significantly different between the two groups except for chyle leakage, which was more frequent in the D3 group. Five-year disease-free survival was 90.2% (95% CI: 84.8-95.9%) in the D3 group, which was significantly (p = 0.028) higher than that (80.5%, 95% CI: 74-87.5%) in the D2 group. There was no significant difference in overall survival between the two groups. CONCLUSION Our results indicate that D3 lymphadenectomy is associated with more favorable 5-year disease-free survival than D2 lymphadenectomy for patients with stage 2/3 right-sided colon cancer. D3 lymphadenectomy might improve oncologic outcomes in consideration of the recurrence rate.
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24
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Wang L, Song B, Chen Y, Hirano Y. D3 lymph node dissection improves the survival outcome in patients with pT2 colorectal cancer. Int J Colorectal Dis 2023; 38:30. [PMID: 36757433 DOI: 10.1007/s00384-023-04326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The extent of lymphadenectomy in patients with pT2 colorectal cancer (CRC) remains controversial. This study aimed to elucidate the effects of D3 and D2 lymph node dissection (LND) on survival in patients diagnosed with pT2 CRC. METHODS This was a retrospective cohort study from a high-volume cancer center in Japan. From April 2007 to December 2020, 6273 patients with primary CRC were included in the study; among these, 616 patients diagnosed with pT2 CRC underwent radical colorectal resection. Propensity score matching (PSM) was applied to balance potential confounding factors, and a total of 104 matched pairs were extracted from the entire cohort. Independent risk factors associated with prognosis were determined by Cox regression analysis. The main outcome measures were overall survival (OS) and cancer-specific survival (CSS). RESULTS Before PSM, there was a statistically significant difference across the cohort in OS and CSS (p = 0.000 and 0.013) between D3 and D2 LND groups; the estimated hazard ratio (HR) was 2.2 (95% confidence interval (CI), 1.1-4.4, p = 0.031) for OS in the D3 LND and 4.4 (95% CI, 1.7 to 11, p = 0.0027) for CSS (p = 0.013). There was also a significant difference (p = 0.024) in OS between the D3 and D2 LND groups in the matched cohort, with an estimated HR for OS of 3.3 (95% CI, 1.2 to 9.1, p = 0.024) and an estimated HR for CSS of 7.2 (95% CI, 1.6 to 33, p = 0.011). CONCLUSIONS D3 LND had a significant survival advantage in the treatment of pT2 CRC. The results of this study provide a theoretical basis for the application of D3 LND in radical surgery for preoperative T2 CRC.
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Affiliation(s)
- Liming Wang
- Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
- Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Bolun Song
- Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yinggang Chen
- Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yasumitsu Hirano
- Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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25
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Patel S, Prem A, Pandey D. Laparoscopic total colectomy: Appraisal of critical views of dissection - A video vignette. Colorectal Dis 2023; 25:338. [PMID: 36029184 DOI: 10.1111/codi.16316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 08/14/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Swapnil Patel
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and MPMMCC, Tata Memorial Centre, Varanasi, India
| | - Amar Prem
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and MPMMCC, Tata Memorial Centre, Varanasi, India
| | - Durgatosh Pandey
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital and MPMMCC, Tata Memorial Centre, Varanasi, India
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26
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Livadaru C, Morarasu S, Bargaoanu R, Iacob S, Frunza T, Musina AM, Velenciuc N, Roata CE, Zugun-Eloae F, Ferariu D, Lunca S, Dimofte MG. The mesocolic apical fragment in complete mesocolic excision colectomies: Should it be analysed separately? A proof-of-concept study. Colorectal Dis 2023; 25:234-242. [PMID: 36227063 DOI: 10.1111/codi.16362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/15/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
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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Affiliation(s)
- Cristian Livadaru
- Radiology and Medical Imaging Department, St Spiridon University Hospital, Iași, Romania.,Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Stefan Morarasu
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Roxana Bargaoanu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Stefan Iacob
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Tudor Frunza
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Ana Maria Musina
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Natalia Velenciuc
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Cristian Ene Roata
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Florin Zugun-Eloae
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,Center of Fundamental Research and Experimental Development in Translational Medicine at Regional Institute of Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Dan Ferariu
- Department of Pathology, Regional Institute of Oncology (IRO), Iasi, Romania
| | - Sorinel Lunca
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
| | - Mihail-Gabriel Dimofte
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iași, Romania
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Smith HG, Chiranth DJ, Schlesinger NH. Do differences in surgical quality account for the higher rate of R1 margins to lymph node metastases in right- versus left-sided Stage III colon cancer: A retrospective cohort study. Colorectal Dis 2022; 25:679-687. [PMID: 36565048 DOI: 10.1111/codi.16459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/06/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
AIM Microscopically positive (R1) margins to lymph node metastases (R1LNM) are associated with poorer oncological outcomes in patients with Stage III colon cancer. R1LNM margins are more common in right-sided cancer, although the cause of this phenomenon is unknown. We sought to investigate whether differences in surgical quality account for the higher rate of R1LNM in right-sided cancers. METHOD Patients treated for Stage III colon cancer from 1 January 2016 to 31 December 2018 were identified using the Danish national cancer registry. Indicators of surgical quality (mesocolic resection grade, median lymph node yield, and length to the distal colonic margin) were compared according to tumour site and margin status. RESULTS In all, 1765 patients were included, 981 (55.6%) with right-sided cancers. R1LNM margins were more common in right-sided cancers (14.4% vs. 6.1%, P < 0.001). All three surgical quality indicators were higher in patients with right-sided cancers (mesocolic resection planes 81.7% vs. 69.5%, P < 0.001; median lymph node yield 28 vs. 25, P < 0.001; ≥5 cm to the distal colon margin 81.2% vs. 53.6%, P < 0.001). When stratified according to margin status, no differences in mesocolic resection planes or resectate length were noted, whilst median lymph node yield was higher in patients with R1LNM margins (29 vs. 27, P = 0.009). CONCLUSION Surgical quality does not appear to be poorer in patients undergoing surgery for right-sided versus left-sided colon cancers in Denmark. Suboptimal surgery does not appear to be responsible for R1LNM margins, implying that these margins may be a surrogate for more aggressive biology.
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Affiliation(s)
- Henry G Smith
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Deepthi J Chiranth
- Department of Pathology, Rigshospital, University of Copenhagen, Copenhagen, Denmark
| | - Nis H Schlesinger
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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28
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Efetov S, Zubayraeva A, Kayaalp C, Minenkova A, Bağ Y, Alekberzade A, Tsarkov P. Selective approach to arterial ligation in radical sigmoid colon cancer surgery with D3 lymph node dissection: A multicenter comparative study. Turk J Surg 2022; 38:382-390. [PMID: 36875272 PMCID: PMC9979549 DOI: 10.47717/turkjsurg.2022.5867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/26/2022] [Indexed: 01/12/2023]
Abstract
Objectives Radical surgery for sigmoid colon cancer is commonly performed with complete mesocolic excision (CME) and apical lymph node dissection, reached by central vascular ligation (CVL) of the inferior mesenteric artery (IMA) and associated extended left colon resection. However, IMA branches can be ligated selectively according to tumor location with D3 lymph node dissection (LND), economic segmental colon resection and tumorspecific mesocolon excision (TSME) if IMA is skeletonized. This study aimed to compare left hemicolectomy with CME and CVL and segmental colon resection with selective vascular ligation (SVL) and D3 LND. Material and Methods Patients (n= 217) treated with D3 LND for adenocarcinoma of the sigmoid colon between January 2013 and January 2020 were included in the study. The approach to vessel ligation, colon resection and mesocolon excision was based on tumor location in the study group, while in the comparison group, left hemicolectomy with routine CVL was performed. Survival rates were estimated as the primary endpoints of the study. Long- and short-term surgery-related outcomes were evaluated as the secondary endpoints of the study. Results The studied approach to the IMA branch ligation was associated with a statistically significant decrease in intraoperative complication rates (2 vs 4, p= 0.024), operative procedure length (225.56 ± 80.356 vs 330.69 ± 175.488, p <0.001), and severe postoperative morbidity (6.2% vs 19.1%, p= 0.017). Meanwhile, the number of examined lymph nodes significantly increased (35.67 vs 26.69 per specimen, p <0.001). There were no statistically significant differences in survival rates. Conclusion Selective IMA branch ligation and TSME resulted in better intraoperative and postoperative outcomes with no difference in survival rates.
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Affiliation(s)
- Sergey Efetov
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Albina Zubayraeva
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Cüneyt Kayaalp
- Clinic of Gastrointestinal Surgery, İnönü University Hospital, Malatya, Türkiye
| | - Alisa Minenkova
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yusuf Bağ
- Department of Surgery, Van Yüzüncü Yıl University Faculty of Medicine, Van, Türkiye
| | - Aftandil Alekberzade
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Petr Tsarkov
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Kojima T, Hino H, Shiomi A, Kagawa H, Yamaoka Y, Manabe S, Chen K, Nanishi K, Yamauchi S, Sugihara K. Long-term outcomes of D2 vs. D3 lymph node dissection for cT2N0M0 colorectal cancer: a multi‑institutional retrospective analysis. Int J Clin Oncol 2022; 27:1717-1724. [PMID: 36029376 DOI: 10.1007/s10147-022-02236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND According to Japanese guidelines, D2 or D3 lymph node dissection (LND) is indicated for cT2N0M0 colorectal cancer (CRC). In this study, we retrospectively compared the long-term outcomes between D2 and D3 LND among patients with cT2N0M0 CRC. METHODS Our sample included 515 patients from the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer database, who underwent surgical resection for cT2N0M0 CRC between January 2009 and December 2012, 195 (37.9%) of whom underwent D2 LND and 320 (62.1%) D3 LND. The D2 and D3 groups were retrospectively compared in terms of long-term outcomes including overall survival (OS) and relapse-free survival (RFS). The prognostic factors for these outcomes were also evaluated. RESULTS The D2 group had significantly older patients and higher proportion of men than the D3 group. The rates of OS (5-year OS; 94.8% in the D3 group vs. 93.4% in the D2 group, p = 0.38) and RFS (5-year RFS; 89.3% in the D3 group vs. 89.1% in the D2 group, p = 0.91) were comparable for both groups. On multivariate analysis, age ≥ 80 years was significantly associated with poor OS. The extent of LND was not associated with either OS or RFS. Long-term outcomes were similar between the two groups, independent of tumor location. CONCLUSION The long-term outcomes did not differ between the D2 and D3 groups and the extent of LND was not associated with prognosis for cT2N0M0 CRC. Therefore, D2 LND may be sufficient for cT2N0N0 CRC treatment.
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Affiliation(s)
- Tadahiro Kojima
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kai Chen
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kenji Nanishi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shinichi Yamauchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-Ku, Tokyo, 113-8510, Japan
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Emile SH. Qualitative umbrella review of systematic reviews on complete mesocolic excision for colon cancer. J Visc Surg 2022; 159:286-297. [PMID: 34020910 DOI: 10.1016/j.jviscsurg.2021.05.003] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) of colon cancer with extended lymphadenectomy was suggested to improve radical resection of colon cancer. This comprehensive review aimed to assess the current literature for the outcomes of CME of colon cancer through an appraisal of the findings of published systematic reviews and meta-analyses. METHODS A systematic literature review searching for the studies that assessed the outcome of CME of colon cancer was conducted. Electronic databases were queried from 2009 through November 2020. The main objectives of this review were to illustrate the technical aspects and outcome of CME and to summarize the findings of the published systematic reviews. RESULTS Thirteen systematic reviews were retrieved. All reviews found CME to provide longer bowel, larger area of mesentery resected, and more lymph nodes (LNs) retrieved than standard colectomy. All systematic reviews except two found similar complication rates between CME and standard colectomy. Four systematic reviews documented the survival benefit of CME in regards to improved overall and disease-free survival. Using the laparoscopic approach for CME did not compromise the oncologic outcomes of the procedures, yet was associated with less intraoperative blood loss, faster recovery, and potential survival benefits. CONCLUSIONS CME is associated with better specimen quality, more LNs clearance, and potential survival benefits compared to standard colectomy. However, the lack of robust data from well-designed multicenter randomized trials may prevent drawing firm conclusions on the oncologic benefits of CME. Further high-quality studies are needed before recommending CME as the standard of care for colon cancer.
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Affiliation(s)
- S H Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura city, Egypt.
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Palmeri M, Peri A, Pucci V, Furbetta N, Gallo V, Di Franco G, Pagani A, Dauccia C, Farè C, Gianardi D, Guadagni S, Bianchini M, Comandatore A, Masi G, Cremolini C, Borelli B, Pollina LE, Di Candio G, Pietrabissa A, Morelli L. Pattern of recurrence and survival after D2 right colectomy for cancer: is there place for a routine more extended lymphadenectomy? Updates Surg 2022; 74:1327-1335. [PMID: 35778547 PMCID: PMC9338120 DOI: 10.1007/s13304-022-01317-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/14/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Conventional Right Colectomy with D2 lymphadenectomy (RC-D2) currently represent the most common surgical treatment of right-sided colon cancer (RCC). However, whether it should be still considered a standard of care, or replaced by a routine more extended D3 lymphadenectomy remains unclear. In the present study, we aim to critically review the patterns of relapse and the survival outcomes obtained from our 11-year experience of RC-D2. METHODS Clinical data of 489 patients who underwent RC-D2 for RCC at two centres, from January 2009 to January 2020, were retrospectively reviewed. Patients with synchronous distant metastases and/or widespread nodal involvement at diagnosis were excluded. Post-operative clinical-pathological characteristics and survival outcomes were evaluated including the pattern of disease relapse. RESULTS We enrolled a total of 400 patients with information follow-up. Postoperative morbidity was 14%. The median follow-up was 62 months. Cancer recurrence was observed in 55 patients (13.8%). Among them, 40 patients (72.7%) developed systemic metastases, and lymph-node involvement was found in 7 cases (12.8%). None developed isolated central lymph-node metastasis (CLM), in the D3 site. The estimated 3- and 5-year relapse-free survival were 86.1% and 84.4%, respectively. The estimated 3- and 5-year cancer-specific OS were 94.5% and 92.2%, respectively. CONCLUSIONS The absence of isolated CLM, as well as the cancer-specific OS reported in our series, support the routine use of RC-D2 for RCC. However, D3 lymphadenectomy may be recommended in selected patients, such as those with pre-operatively known CLM, or with lymph-node metastases close to the origin of the ileocolic vessels.
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Affiliation(s)
- Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Andrea Peri
- Department of General Surgery, University of Pavia, 27100, Pavia, Italy
| | - Valentina Pucci
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Virginia Gallo
- Department of General Surgery, University of Pavia, 27100, Pavia, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Anna Pagani
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Chiara Dauccia
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Camilla Farè
- Department of General Surgery, University of Pavia, 27100, Pavia, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Annalisa Comandatore
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | - Gianluca Masi
- Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Chiara Cremolini
- Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Beatrice Borelli
- Oncology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | | | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy
| | | | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy, Via Paradisa 2, 56125, Pisa, Italy.
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, 56124, Pisa, Italy.
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Degiuli M, Solej M, Resendiz Aguilar HA, Marchiori G, Reddavid R. Complete mesocolic excision in comparison with conventional surgery for right colon cancer: a nationwide multicenter study of the Italian Society of Surgical Oncology colorectal cancer network (CoME-in trial). Study protocol for a randomized controlled trial. Jpn J Clin Oncol 2022; 52:1232-1241. [PMID: 35849819 DOI: 10.1093/jjco/hyac116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/02/2022] [Indexed: 11/14/2022] Open
Abstract
Complete mesocolic excision with central vascular ligation, or simply CME, includes the sharp dissection along the mesocolic visceral and parietal layers, with the ligation of the main vessels at their origins. To date, there is low evidence on its safety and efficacy. This is a study-protocol of a multicenter, randomized, superiority trial in patients with right-sided colon cancer. It aims to investigate whether the complete mesocolic excision improves the oncological outcomes as compared with conventional right hemicolectomy, without worsening early outcomes. Data on efficacy and safety of complete mesocolic excision are available only from a large trial recruiting eastern patients and from a low-volume single-center western study. No results on survival are still available. For this reason, complete mesocolic excision continues to be a controversial topic in daily practice, particularly in western world. This new nationwide multicenter large-volume trial aims to provide further data on western patients, concerning both postoperative and survival outcomes.
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Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, Surgical Oncology and Digestiver Surgery, San Luigi University Hospital, Orbassano, 10043 Torino, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, Surgical Oncology and Digestiver Surgery, San Luigi University Hospital, Orbassano, 10043 Torino, Italy
| | - Hogla Aridai Resendiz Aguilar
- University of Turin, Department of Oncology, Surgical Oncology and Digestiver Surgery, San Luigi University Hospital, Orbassano, 10043 Torino, Italy
| | - Giulia Marchiori
- University of Turin, Department of Oncology, Surgical Oncology and Digestiver Surgery, San Luigi University Hospital, Orbassano, 10043 Torino, Italy
| | - Rossella Reddavid
- University of Turin, Department of Oncology, Surgical Oncology and Digestiver Surgery, San Luigi University Hospital, Orbassano, 10043 Torino, Italy
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Consensus statements on complete mesocolic excision for right-sided colon cancer-technical steps and training implications. Surg Endosc 2022; 36:5595-5601. [PMID: 35790593 PMCID: PMC9283340 DOI: 10.1007/s00464-021-08395-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
Background CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways. Methods Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus. Results Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme. Conclusions Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08395-0.
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Abstract
The following article summarizes technical aspects of how to operate in the mesentery during complete mesocolic excision (CME). Increasingly, CME is being adopted and as such it is important to establish the anatomical basis of the techniques involved. This review thus serves to provide that foundation and explains the surgical techniques built on it.
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Affiliation(s)
- Jordan Fletcher
- Department of Colorectal Surgery, St. Mark's Hospital, London, United Kingdom
| | - Danilo Miskovic
- Department of Colorectal Surgery, St. Mark's Hospital, London, United Kingdom
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Chen X, Tu J, Xu X, Gu W, Qin L, Qian H, Jia Z, Ma C, Xu Y. Adjuvant Chemotherapy Benefit in Elderly Stage II/III Colon Cancer Patients. Front Oncol 2022; 12:874749. [PMID: 35747799 PMCID: PMC9209735 DOI: 10.3389/fonc.2022.874749] [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: 02/12/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStudies providing more evidence to guide adjuvant chemotherapy decisions in elderly colon cancer patients are expected. MethodsWe obtained data from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2012. Kaplan-Meier survival curves were constructed to calculate the cancer-specific survival (CSS) rate, and comparisons of survival difference between different subgroups were performed using the log-rank test. Multivariate Cox proportional hazards regression models were carried out to estimate hazard ratio (HR) and 95% confidence intervals (CIs) of different clinicopathological characteristics.ResultsIn stage II colon cancer patients aged 70 years or older, the Kaplan-Meier survival analysis showed that the 5-year CSS rates of no chemotherapy and chemotherapy groups were 82.0% and 72.4%, respectively (P < 0.001). In stage III colon cancer patients aged 70 years or older, the Kaplan-Meier survival analysis showed that the 5-year CSS rates of no chemotherapy and chemotherapy groups were 50.7% and 61.3%, respectively (P < 0.001). Patients with chemotherapy receipt were independently associated with a 35.8% lower cancer-specific mortality rate (HR = 0.642, 95% CI: 0.620-0.665, P < 0.001) compared with those who did not receive chemotherapy.ConclusionsAdjuvant chemotherapy should be considered during the treatment of stage III colon cancer patients aged 70 years or older, but the chemotherapy benefit in elderly stage II colon cancer is suboptimal.
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Affiliation(s)
- Xin Chen
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junhao Tu
- Department of General Surgery, Suzhou Wuzhong People’s Hospital, Suzhou, China
| | - Xiaolan Xu
- Department of Gastroenterology, Xiangcheng People’s Hospital, Suzhou, China
| | - Wen Gu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Qin
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haixin Qian
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenyu Jia
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuntao Ma
- Department of Gastroenterology, Xiangcheng People’s Hospital, Suzhou, China
- *Correspondence: Yinkai Xu, ; ; Chuntao Ma,
| | - Yinkai Xu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Yinkai Xu, ; ; Chuntao Ma,
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Connelly TM, Clancy C, Steele SR, Kessler H. Lymph node recurrence after right colon resection for cancer: evidence for the utilisation of complete mesocolic excision. BMJ Case Rep 2022; 15:e247904. [PMID: 35550325 PMCID: PMC9109023 DOI: 10.1136/bcr-2021-247904] [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] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
Abstract
Complete mesocolic excision (CME) of colon cancer is a resection performed along embryological planes to include the completely intact mesentery surrounding the tumour with a high central vascular ligation. The aim is to remove all lymph nodes draining the cancer. Proponents of the technique cite the significantly decreased local recurrence and improved 5-year survival rates associated with CME versus conventional colectomy. Although increasingly performed in many centres, it has not yet gained widespread acceptance as it is technically more challenging and can incur an increased bleeding risk. A man in his 80s underwent a conventional right hemicolectomy for a pT4aN2aM0 ascending colon cancer at another institution. This was followed by chemotherapy. He presented to our institution 2 years later with an isolated 3.7×3.2 cm mesenteric tumour adjacent to his anastomosis. There was no intraluminal recurrence. He then underwent a repeat extended right colectomy with CME. Pathology confirmed lymph node recurrence. His case demonstrates the importance of CME in reducing carcinoma recurrence risk.
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Affiliation(s)
| | - Cillian Clancy
- Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Steele
- Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
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Xu YX, Huang Y, Wang XJ, Ye DX, Chi P. Clinical significance of 206 station lymph node in transverse colon cancer. Cancer Med 2022; 11:2366-2376. [PMID: 35437894 PMCID: PMC9189469 DOI: 10.1002/cam4.4626] [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: 03/20/2021] [Revised: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Lymph node (LN) metastasis is crucial in determining the prognosis and treatment options for colon cancer patients. Our work was to study whether the lymph nodes beyond D3 station in transverse colon cancer, especially 206 LN, should be dissected. Methods A total of 225 patients within our department were reviewed. The primary and secondary endpoints were overall survival (OS) and disease‐free survival (DFS). We employed Propensity score weighting (PSW) for weighing participants to balance observed confounders between the 206D+ group and the 206D− group. Results The rate of metastasis in station 206 was 9.3%. Only T stage (OR, 3.009; 95% CI, 1.018–8.892), N stage (OR, 9.818; 95% CI, 1.158–83.227), and M stage (OR, 26.126; 95% CI, 1.274–535.945) were an independent risk factor for 206 station metastasis in multivariate logistic analysis. The 206D+ group had a similarly survival than the 206D− group (3‐year DFS, 89.6% v 85.9%; p = 0.389; 3‐year OS, 94.6% v 85.3% p = 0.989). PSW further verified it. Metastasis of 206 station LN is not an independent prognostic factor, but a predictive factor of DFS. Conclusion Station 206 LN positive is a predictive factor for DFS. Only the patient with T1‐3, N+ who is at a high risk of 206 station LN metastases should consider dissecting 206 station LN.
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Affiliation(s)
- Yu Xin Xu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiao Jie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Dao Xiong Ye
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
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Ausmaß und Technik der chirurgischen Resektion beim Kolonkarzinom. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seow-En I, Tzu-Liang Chen W. Complete mesocolic excision with central venous ligation/D3 lymphadenectomy for colon cancer – A comprehensive review of the evidence. Surg Oncol 2022; 42:101755. [DOI: 10.1016/j.suronc.2022.101755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 02/07/2023]
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Fletcher J, Ilangovan R, Hanna G, Miskovic D, Lung P. The impact of three-dimensional reconstruction and standardised CT interpretation (AMIGO) on the anatomical understanding of mesenteric vascular anatomy for planning complete mesocolic excision surgery: A randomised crossover study. Colorectal Dis 2022; 24:388-400. [PMID: 34989089 DOI: 10.1111/codi.16041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Preoperative planning is a crucial aspect of safe complete mesocolic excision (CME) surgery. 3D models derived from imaging may help improve anatomical understanding of the complex vascular anatomy. Here, we assessed the effect of 3D models on surgeons' anatomical understanding in comparison to a systematic approach for CT scan interpretation (AMIGO). METHOD Fifteen cases were included in the study. Two GI radiology consultants reviewed each scan to ascertain the vascular anatomy. Virtual 3D models were produced and displayed on a web-based platform (https://skfb.ly/6OZUZ). A total of 13 surgical trainees were recruited. Candidates were assessed after baseline anatomical training and subsequently using the AMIGO method and 3D models. Five cases were randomly allocated in each round of testing for each participant. The primary outcome measure was an objective vascular anatomy knowledge score. The secondary outcome measure was subjective feedback from participants. RESULTS Both 3D and AMIGO significantly improved anatomical understanding in comparison to baseline testing. However, 3D was superior to AMIGO (3D [n = 65; median score 8/14] vs. AMIGO [n = 65; median score 6/14; p < 0.0001]. For 13/15 patient cases examined, 3D was superior to the AMIGO method. Eleven participants demonstrated better anatomical understanding using 3D models versus AMIGO. Ten participants preferred 3D models in comparison to standard CT imaging. CONCLUSIONS 3D models improve anatomical understanding of mesenteric vascular anatomy in a group of colorectal surgical trainees in comparison to a formal CT interpretation method. 3D models may be a useful planning adjunct to 2D imaging for CME surgery.
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Affiliation(s)
- Jordan Fletcher
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - George Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danilo Miskovic
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Phillip Lung
- St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Yan B, Xiong J, Ye Q, Xue T, Xiang J, Xu M, Li F, Wen W. Correlation and prognostic implications of intratumor and tumor draining lymph node Foxp3 + T regulatory cells in colorectal cancer. BMC Gastroenterol 2022; 22:122. [PMID: 35296257 PMCID: PMC8925044 DOI: 10.1186/s12876-022-02205-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prognostic value of intratumor T regulatory cells (Tregs) in colorectal cancer (CRC) was previously reported, but the role of these cells in tumor draining lymph nodes (TDLNs) was less addressed. METHODS A total of 150 CRC stages I-IV were retrospectively enrolled. Intratumor and TDLN Tregs were examined by immunohistochemical assay. The association of these cells was estimated by Pearson correlation. Survival analyses of subgroups were conducted by Kaplan-Meier curves, and the log-rank test and risk factors for survival were tested by the Cox proportional hazard model. RESULTS High accumulation of Tregs in tumors was significant in patients with younger age and good histological grade, where enrichment of these cells in TDLNs was more apparent in those with node-negative disease and early TNM stage disease, both of which were more common in early T stage cases. A significant correlation of intratumoral and TDLN Tregs was detected. Patients with higher intratumoral Tregs displayed significantly better PFS and OS than those with lower Tregs. However, no such differences were found, but a similar prognostic prediction trend was found for these cells in TDLNs. Finally, intratumoral Tregs were an independent prognostic factor for both PFS (HR = 0.97, 95% CI 0.95-0.99, P < 0.01) and OS (HR = 0.98, 95% CI 0.95-1.00, P = 0.04) in the patients. CONCLUSIONS Higher intratumor Tregs were associated with better survival in CRC. Although no such role was found for these cells in TDLNs, the positive correlation and similar prognostic prediction trend with their intratumoral counterparts may indicate a parallelized function of these cells in CRC.
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Affiliation(s)
- Bing Yan
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan province, 572000, People's Republic of China
| | - Jianmei Xiong
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan Province, 572000, People's Republic of China
| | - Qianwen Ye
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan province, 572000, People's Republic of China
| | - Tianhui Xue
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan province, 572000, People's Republic of China
| | - Jia Xiang
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan province, 572000, People's Republic of China
| | - Mingyue Xu
- Department of General Surgery, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan Province, 572000, People's Republic of China
| | - Fang Li
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan province, 572000, People's Republic of China.
| | - Wei Wen
- Department of General Surgery, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya City, Hainan Province, 572000, People's Republic of China.
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Kim HJ, Park JW. Surgical outcomes of various surgical approaches for transverse colon cancer. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:1-6. [PMID: 35603341 PMCID: PMC8977494 DOI: 10.7602/jmis.2022.25.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022]
Abstract
The transverse colon has anatomical peculiarities in the middle position between the foregut and the midgut. Because the transverse colon harbors a flexure at both ends, mobilization of the transverse colon can be especially challenging compared with other colons. Although transverse colon cancer is relatively uncommon, an optimal surgical management for transverse colon cancer must be established. In transverse colon cancer, proximity to the pancreas and variation in arterial and venous anatomy make radical resection more difficult. Dissection of lymph nodes around the middle colic vessels is a critical step in transverse colon cancer resection. The proximity of the middle colic vessels to the superior mesenteric vessels contributes to the complexity of this step, making it challenging for less-trained surgeons. For these reasons, patients with transverse colon cancer were not included in most landmark studies that compared laparoscopic surgery with open surgery. More radical operations, such as subtotal colectomy or extended right or left hemicolectomy, can be performed for transverse colon cancer to secure an adequate lymphadenectomy. Such cancers have also been treated with limited segmental colectomies, such as right, transverse, or left colectomy. Currently, there is still a lack of standardized definitions and procedures. Therefore, it is time to discuss and establish optimal surgical treatments for transverse colon cancer.
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Affiliation(s)
- Hyo Jun Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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Planellas P, Marinello F, Elorza G, Golda T, Farrés R, Espín-Basany E, Enríquez-Navascués JM, Kreisler E, Cornejo L, Codina-Cazador A. Extended Versus Standard Complete Mesocolon Excision in Sigmoid Colon Cancer: A Multicenter Randomized Controlled Trial. Ann Surg 2022; 275:271-280. [PMID: 34417367 DOI: 10.1097/sla.0000000000005161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether extended complete mesocolic excision (e-CME) for sigmoid colon cancer improves oncological outcomes without compromising morbidity or functional results. BACKGROUND In surgery for cancer of the sigmoid colon and upper rectum, s-CME removes the lymphofatty tissue surrounding the inferior mesenteric artery (IMA), but not the lymphofatty tissue surrounding the portion of the inferior mesenteric vein that does not run parallel to the IMA. Evidence about the safety and efficacy of extending CME to include this tissue is lacking. METHODS This single-blind study randomized sigmoid cancer patients at 4 centers to undergo e-CME or s-CME. The primary outcome was the total number of lymph nodes harvested. Secondary outcomes included disease-free and overall survival at 2 years, morbidity, and bowel and genitourinary function. Clinicaltrials.gov: NCT03107650. RESULTS We analyzed 93 patients (46 e-CME and 47 s-CME). Perioperative outcomes were similar between groups. No differences between groups were found in the total number of lymph nodes harvested [21 (interquartile range, IQR, 14-29) in e-CME vs 20 (IQR, 15-27) in s-CME, P = 0.873], morbidity (P = 0.829), disease-free survival (P = 0.926), or overall survival (P = 0.564). The extended specimen yielded a median of 1 lymph node (range, 0-6), none of which were positive.Bowel function recovery was similar between arms at all timepoints. Males undergoing e-CME had worse recovery of urinary function (P = 0.026). CONCLUSION Extending lymphadenectomy to include the IMV territory did not increase the number of lymph nodes or improve local recurrence or survival rates.
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Affiliation(s)
- Pere Planellas
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Franco Marinello
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Garazi Elorza
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Donostia, Donostia, Spain
| | - Thomas Golda
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Ramon Farrés
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jose Mari Enríquez-Navascués
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Donostia, Donostia, Spain
| | - Esther Kreisler
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Lídia Cornejo
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Antoni Codina-Cazador
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
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Livadaru C, Moscalu M, Ghitun FA, Huluta AR, Terinte C, Ferariu D, Lunca S, Dimofte GM. Postoperative Quality Assessment Score Can Select Patients with High Risk for Locoregional Recurrence in Colon Cancer. Diagnostics (Basel) 2022; 12:363. [PMID: 35204454 PMCID: PMC8871190 DOI: 10.3390/diagnostics12020363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Monitoring surgical quality has been shown to reduce locoregional recurrence (LRR). We previously showed that the arterial stump length (ASL) after complete mesocolic excision (CME) is a reproducible quality instrument and correlates with the lymph-node (LN) yield. We hypothesized that generating an LRR prediction score by integrating the ASL would predict the risk of LRR after suboptimal surgery. METHODS 502 patients with curative resections for stage I-III colon cancer were divided in two groups (CME vs. non-CME) and compared in terms of surgical data, ASL-derived parameters, pathological parameters, LRR and LRR-free survival. A prediction score was generated to stratify patients at high risk for LRR. RESULTS The ASL showed significantly higher values (50.77 mm ± 28.5 mm) with LRR vs. (45.59 mm ± 28.1 mm) without LRR (p < 0.001). Kaplan-Meier survival analysis showed a significant increase in LRR-free survival at 5.58 years when CME was performed (Group A: 81%), in contrast to non-CME surgery (Group B: 67.2%). CONCLUSIONS The prediction score placed 76.6% of patients with LRR in the high-risk category, with a strong predictive value. Patients with long vascular stumps and positive nodes could benefit from second surgery to complete the mesocolic excision.
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Affiliation(s)
- Cristian Livadaru
- Surgical Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Radiology and Medical Imaging Department, St. Spiridon Emergency County Clinical Hospital, 700111 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | | | - Cristina Terinte
- Department of Pathology, Regional Oncology Institute, 700483 Iasi, Romania
| | - Dan Ferariu
- Department of Pathology, Regional Oncology Institute, 700483 Iasi, Romania
| | - Sorinel Lunca
- Surgical Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, 700483 Iasi, Romania
| | - Gabriel Mihail Dimofte
- Surgical Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- 2nd Clinic of Surgical Oncology, Regional Oncology Institute, 700483 Iasi, Romania
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Zheng HD, Xu JH, Liu YR, Sun YF. Analysis of 20 patients with laparoscopic extended right colectomy. World J Clin Cases 2022; 10:528-537. [PMID: 35097078 PMCID: PMC8771377 DOI: 10.12998/wjcc.v10.i2.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Currently, the standard surgical procedure for right colon cancer is complete mesocolic excision. Whether preventive extended lymph node dissection for colon cancer located in the hepatic flexure or right transverse colon should be performed remains controversial because the safety and effectiveness of the operation have not been proven, and infrapyloric lymph nodes (No. 206) and lymph nodes in the greater curvature of the stomach (No. 204) have not been strictly defined and distinguished as surgical indicators in previous studies.
AIM To analyze the metastatic status of infrapyloric lymph nodes and lymph nodes of the greater curvature of the stomach and perioperative complications and systematically evaluate the feasibility and safety of laparoscopic extended right colectomy using prospective data collected retrospectively.
METHODS The study was a clinical study. Twenty patients with colon cancer who underwent laparoscopic extended right colon resection in our hospital from June 2020 to May 2021 were included.
RESULTS Among the patients who underwent extended right colon resection, there were no intraoperative complications or conversion to laparotomy; 2 patients had gastrocolic ligament lymph node metastasis, and 5 patients had postoperative complications. The patients with postoperative complications received conservative treatment.
CONCLUSION Laparoscopic extended right colon resection is safe. However, malignant tumors located in the liver flexure or the right-side transverse colon are more likely to metastasize to the gastrocolic ligament lymph nodes, and notably, the incidence of gastroparesis was high. The number of patients was small, and the follow-up time was short. It is necessary to further increase the sample size to evaluate the No. 204 and No. 206 lymph node metastasis rates and the long-term survival impact.
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Affiliation(s)
- Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yu-Rong Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Ya-Feng Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Struys MJ, Ceelen WP. Anatomical and temporal patterns of lymph node metastasis in colorectal cancer. THE LYMPHATIC SYSTEM IN COLORECTAL CANCER 2022:131-151. [DOI: 10.1016/b978-0-12-824297-1.00001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Westwood AC, Tiernan JP, West NP. Complete mesocolic excision in colon cancer. THE LYMPHATIC SYSTEM IN COLORECTAL CANCER 2022:167-192. [DOI: 10.1016/b978-0-12-824297-1.00007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Girnyi S, Ekman M, Marano L, Roviello F, Połom K. Complete Mesogastric Excisions Involving Anatomically Based Concepts and Embryological-Based Surgeries: Current Knowledge and Future Challenges. Curr Oncol 2021; 28:4929-4937. [PMID: 34898586 PMCID: PMC8628739 DOI: 10.3390/curroncol28060413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
Surgeries for gastrointestinal tract malignancies are based on the paradigm that we should remove the tumour together with its lymphatic drainage in one block. This concept was initially proposed in rectal surgery and called a total mesorectal excision. This procedure gained much interest and has improved oncological results in rectal cancer surgery. The same idea for mesogastric and complete mesogastric excisions was proposed but, because of the complexity of the gastric mesentery, it has not become a standard technique. In this review, we analysed anatomical and embryological factors, proposed technical aspects of this operation and incorporated the available initial results of this concept. We also discussed analogies to other gastrointestinal organs, as well as challenges to this concept.
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Affiliation(s)
- Sergii Girnyi
- Department of Surgical Oncology, Medical University of Gdansk, 80-070 Gdansk, Poland; (S.G.); (M.E.); (K.P.)
| | - Marcin Ekman
- Department of Surgical Oncology, Medical University of Gdansk, 80-070 Gdansk, Poland; (S.G.); (M.E.); (K.P.)
| | - Luigi Marano
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Karol Połom
- Department of Surgical Oncology, Medical University of Gdansk, 80-070 Gdansk, Poland; (S.G.); (M.E.); (K.P.)
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A novel fluorescent c-met targeted imaging agent for intra-operative colonic tumour mapping: Translation from the laboratory into a clinical trial. Surg Oncol 2021; 40:101679. [PMID: 34839199 DOI: 10.1016/j.suronc.2021.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/26/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The c-Met protein is overexpressed in many gastrointestinal cancers. We explored EMI-137, a novel c-Met targeting fluorescent probe, for application in fluorescence-guided colon surgery, in HT-29 colorectal cancer (CRC) cell line and an in vivo murine model. METHODS HT-29 SiRNA transfection confirmed specificity of EMI-137 for c-Met. A HT-29 CRC xenograft model was developed in BALB/c mice, EMI-137 was injected and biodistribution analysed through in vivo fluorescent imaging. Nine patients, received a single intravenous EMI-137 bolus (0.13 mg/kg), 1-3 h before laparoscopic-assisted colon cancer surgery (NCT03360461). Tumour and LN fluorescence was assessed intraoperatively and correlated with c-Met expression in eight samples by immunohistochemistry. FINDINGS c-Met expression HT-29 cells was silenced and imaged with EMI-137. Strong EMI-137 uptake in tumour xenografts was observed up to 6 h post-administration. At clinical trial, no serious adverse events related to EMI-137 were reported. Marked background fluorescence was observed in all participants, 4/9 showed increased tumour fluorescence over background; 5/9 had histological LN metastases; no fluorescent LN were detected intraoperatively. All primary tumours (8/8) and malignant LN (15/15) exhibited high c-Met protein expression. INTERPRETATION EMI-137, binds specifically to the human c-Met protein, is safe, and with further refinement, shows potential for application in fluorescence-guided surgery.
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Surgical Oncology: Multidisciplinarity to Improve Cancer Treatment and Outcomes. Curr Oncol 2021; 28:4471-4473. [PMID: 34898580 PMCID: PMC8628680 DOI: 10.3390/curroncol28060379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
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