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A radiological and pathological assessment of ileocolic pedicle length as a predictor of lymph node retrieval following right hemicolectomy for caecal cancer

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Abstract

Background

In colon cancer, the number of harvested lymph nodes is critical for pathological staging. It has been proposed that the more central the mesenteric vascular ligation, the greater the nodal yield. The aim of the current study was to determine the association of radiological and pathological ileocolic pedicle length on nodal harvest following right hemicolectomy for caecal cancer.

Methods

A series of 50 patients undergoing right hemicolectomy for adenocarcinoma underwent specimen evaluation. Preoperative computed tomography images were reconstructed and analysed to determine the direct (vessel origin to caecum) ileocolic pedicle length.

Results

The median pathological distance from the tumour to the high vascular tie was 80 mm, and median nodal yield was 16.5 nodes. Radiological pedicle length did not correlate with the pathological distance from the tumour to the high vascular tie or nodal yield; however, the pathological pedicle length did correlate with the total nodal yield (r 2: 0.343, p = 0.015). The median pathologically determined length of colon resected (r 2: 0.153, p = 0.289), ileum resected (r 2: 0.087, p = 0.568) and total specimen length resected (r 2: 0.182, p = 0.205) did not correlate with the total nodal yield. An ileal specimen length ≤25 mm [hazard ratio (HR) 14.8, 95 % confidence interval (CI) 1.1–194.5, p = 0.040] and a well-differentiated tumour (HR 10.5, 95 % CI 1.1–95.9, p = 0.037) increased the likelihood of retrieving <12 lymph nodes.

Conclusions

Based on these data, pathologic pedicle length is a determining factor in lymph node retrieval. Preoperative radiological calculation of pedicle length does not help predict the number of lymph nodes retrieved.

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Authors and Affiliations

  1. Centre for Colorectal Disease, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    J. G. Solon, J. P. Burke, S. T. Martin, K. Sheahan & D. C. Winter

  2. Department of Colorectal Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    J. G. Solon, J. P. Burke, S. T. Martin & D. C. Winter

  3. Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    A. Cahalane & J. W. McCann

  4. Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    D. Gibbons & K. Sheahan

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  1. J. G. Solon
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  2. A. Cahalane
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  4. D. Gibbons
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Correspondence to D. C. Winter.

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The authors declare that they have no conflict of interest.

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The study was carried out to appropriate ethical standards and were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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In this article, no patient care was involved.

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Solon, J.G., Cahalane, A., Burke, J.P. et al. A radiological and pathological assessment of ileocolic pedicle length as a predictor of lymph node retrieval following right hemicolectomy for caecal cancer. Tech Coloproctol 20, 545–550 (2016). https://doi.org/10.1007/s10151-016-1483-x

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  • DOI: https://doi.org/10.1007/s10151-016-1483-x

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