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Prognostic Impact of Distribution of Lymph Node Metastases in Stage III Colon Cancer

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Abstract

Background

Complete mesocolic excision (CME) with central vascular ligation (CVL) is a well-known concept in colon cancer surgery. However, data on the oncological benefits of CVL are scarce. The objective of this study was to evaluate the prognostic significance of the distribution of lymph node metastases (LND) in patients with stage III colon cancer who underwent CME with CVL.

Methods

In total, 446 consecutive patients who underwent curative resection for stage III colon cancer from 2005 to 2011 were analyzed. Patients were classified as having LND1 (metastases in pericolic nodes), LND2 (metastases in intermediate nodes), or LND3 (metastases in main nodes). Survival outcomes were compared among the three groups.

Results

LND1, LND2, and LND3 were identified in 299 (67.0 %), 122 (27.4 %), and 25 (5.6 %) patients, respectively. The 5-year overall survival and relapse-free survival (RFS) of all patients were 86.7 and 76.2 %, respectively. The 5-year RFS of patients with LND1, LND2, and LND3 were 82.8, 65.4, and 52.0 %, respectively (p < 0.0001). Multivariate analysis showed that LND2 was an independent prognostic factor for RFS (p = 0.0185), although the significance of LND3 was marginal (p = 0.0621). Among patients with pN1, the 5-year RFS of patients with LND1 and LND2+3 were significantly different (84.4 vs. 71.5 %, respectively, p = 0.0102), and similar tendency was found between patients with pN2-LND1 and pN2-LND2+3 (72.6 vs. 53.1 %, p = 0.0428).

Conclusion

The high 5-year survival rates of patients with stage III colon cancer, even those with LND2 and LND3, would justify CVL as the standard procedure for advanced colon cancer.

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Author contributions

TN and TA contributed to the conception and design of this study. All the authors acquired, analyzed, and interpreted the data. All the authors contributed to drafting the article and to its critical revision. All the authors read and approved the final version.

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    Authors and Affiliations

    1. Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

      Toshiya Nagasaki, Takashi Akiyoshi, Yoshiya Fujimoto, Tsuyoshi Konishi, Satoshi Nagayama, Yosuke Fukunaga & Masashi Ueno

    2. Department of Clinical Genetic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

      Masami Arai

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    1. Toshiya Nagasaki
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    2. Takashi Akiyoshi
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    4. Tsuyoshi Konishi
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    5. Satoshi Nagayama
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    8. Masashi Ueno
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    Correspondence to Takashi Akiyoshi.

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    All the authors have no conflict of interest or financial ties to disclose in association with this study.

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    Toshiya Nagasaki and Takashi Akiyoshi have contributed equally to this work.

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    Nagasaki, T., Akiyoshi, T., Fujimoto, Y. et al. Prognostic Impact of Distribution of Lymph Node Metastases in Stage III Colon Cancer. World J Surg 39, 3008–3015 (2015). https://doi.org/10.1007/s00268-015-3190-6

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    • DOI: https://doi.org/10.1007/s00268-015-3190-6

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