Optimal bowel resection margin in colon cancer surgery: prospective multicentre cohort study with lymph node and feeding artery mapping

被引:18
作者
Ueno, Hideki [1 ]
Hase, Kazuo [1 ]
Shiomi, Akio [2 ]
Shiozawa, Manabu [3 ]
Ito, Masaaki [4 ]
Sato, Toshihiko [5 ]
Hashiguchi, Yojiro [6 ]
Kusumi, Takaya [7 ]
Kinugasa, Yusuke [8 ]
Ike, Hideyuki [9 ]
Matsuda, Kenji [10 ]
Yamada, Kazutaka [11 ]
Komori, Koji [12 ]
Takahashi, Keiichi [13 ]
Kanemitsu, Yukihide [14 ]
Ozawa, Heita [15 ]
Ohue, Masayuki [16 ]
Masaki, Tadahiko [17 ]
Takii, Yasumasa [18 ]
Ishibe, Atsushi [19 ]
Watanabe, Jun [20 ]
Toiyama, Yuji [21 ]
Sonoda, Hiromichi [22 ]
Koda, Keiji [23 ]
Akagi, Yoshito [24 ]
Itabashi, Michio [25 ]
Nakamura, Takahiro [26 ]
Sugiharaaa, Kenichi [27 ]
机构
[1] Natl Def Med Coll, Dept Surg, 3-2 Namiki, Tokorozawa, Saitama 3598513, Japan
[2] Shizuoka Canc Ctr Hosp, Div Colorectal Surg, Shizuoka, Japan
[3] Kanagawa Canc Ctr, Dept Gastrointestinal Surg, Yokohama, Kanagawa, Japan
[4] Natl Canc Ctr Hosp East, Dept Surg Oncol, Colorectal & Pelv Surg Div, Chiba, Japan
[5] Yamagata Prefectural Cent Hosp, Dept Surg, Yamagata, Japan
[6] Teikyo Univ, Dept Surg, Sch Med, Tokyo, Japan
[7] Keiyukai Sappro Hosp, Dept Surg, Sapporo, Hokkaido, Japan
[8] Tokyo Med & Dent Univ, Dept Gastrointestinal Surg, Tokyo, Japan
[9] Saisei Kai Yokohama Shi Nanbu Hosp, Dept Surg, Yokohama, Kanagawa, Japan
[10] Wakayama Med Univ, Sch Med, Dept Surg 2, Wakayama, Japan
[11] Takano Hosp, Coloproctol Ctr, Dept Gastroenterol Surg, Kumamoto, Japan
[12] Aichi Canc Ctr Hosp, Dept Gastroenterol Surg, Nagoya, Aichi, Japan
[13] Komagome Hosp, Dept Surg, Tokyo Metropolitan Canc & Infect Dis Ctr, Tokyo, Japan
[14] Natl Canc Ctr, Dept Colorectal Surg, Tokyo, Japan
[15] Tochigi Canc Ctr, Dept Surg, Utsunomiya, Tochigi, Japan
[16] Osaka Int Canc Inst, Dept Gastroenterol Surg, Osaka, Japan
[17] Kyorin Univ, Dept Surg, Sch Med, Tokyo, Japan
[18] Niigata Canc Ctr Hosp, Dept Surg, Niigata, Japan
[19] Yokohama City Univ, Dept Gastroenterol Surg, Grad Sch Med, Yokohama, Kanagawa, Japan
[20] Yokohama City Univ, Gastroenterol Ctr, Dept Surg, Med Ctr, Yokohama, Kanagawa, Japan
[21] Mie Univ, Dept Gastrointestinal & Pediat Surg, Grad Sch Med, Tsu, Mie, Japan
[22] Shiga Univ Med Sci, Dept Surg, Shiga, Japan
[23] Teikyo Univ, Dept Surg, Chiba Med Ctr, Chiba, Japan
[24] Kurume Univ, Dept Surg, Sch Med, Fukuoka, Japan
[25] Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan
[26] Natl Def Med Coll, Lab Math, Saitama, Japan
[27] Tokyo Med & Dent Univ, Tokyo, Japan
来源
LANCET REGIONAL HEALTH-WESTERN PACIFIC | 2023年 / 33卷
关键词
Colon cancer; Pericolic lymph node; Regional lymph node; Tumour-node-metastasis classification; COMPLETE MESOCOLIC EXCISION; COLORECTAL-CANCER; GUIDELINES; DISSECTION; CARCINOMA; SPECIMENS; LIGATION; SPREAD; EXTENT;
D O I
10.1016/j.lanwpc.2022.100680
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background There are no standardised criteria for the 'regional' pericolic node in colon cancer, which represents a major cause of the international uncertainty regarding the optimal bowel resection margin. This study aimed to determine 'regional' pericolic nodes based on prospective lymph node (LN) mapping.Methods According to preplanned in vivo measurements of the bowel, the anatomical distributions of the feeding artery and LNs were determined in 2996 stages I-III colon cancer patients who underwent colectomy with resection margin >10 cm at 25 institutions in Japan.Findings The mean number of retrieved pericolic nodes was 20.9 (standard deviation, 10.8) per patient. In all patients except seven (0.2%), the primary feeding artery was distributed within 10 cm of the primary tumour. The metastatic pericolic node most distant from the primary tumour was within 3 cm in 837 patients, 3-5 cm in 130 patients, 5-7 cm in 39 patients and 7-10 cm in 34 patients. Only four patients (0.1%) had pericolic lymphatic spread beyond 10 cm; all of whom had T3/4 tumours accompanying extensive mesenteric lymphatic spread. The location of metastatic pericolic node did not differ by the feeding artery's distribution. Postoperatively, none of the 2996 patients developed recurrence in the remaining pericolic nodes. Interpretation The pericolic nodes designated as 'regional' were those located within 10 cm of the primary tumours, which should be fully considered when determining the bowel resection margin, even in the era of complete mesocolic excision.
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页数:13
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