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The relation between oncologic outcomes and metastatic lymph node location following laparoscopic resection of stage III colon cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Colon cancers are staged by assessing more than 12 lymph nodes, but there is still a controversy over the number of lymph nodes. Only a few studies of metastatic lymph node position in colon cancer have been published with its significance not completely understood. This study aimed to compare survival rates according to metastatic lymph node position following radical lymph node dissection for stage III colon cancers.

Methods

This retrospective study evaluated data prospectively collected at a tertiary teaching hospital from 349 patients who underwent laparoscopic colectomy with radical node dissection between December 2009 and December 2014. Lymph nodes were numbered and classified into lymph node metastasis (LNM) groups LNM1, LNM2, and LNM3 and their short- and long-term outcomes were compared.

Results

The LNM1, LNM2, and LNM3 groups included 229, 94, and 26 patients, respectively. Patient characteristics differed by locations (p < 0.001). A mean 34.6 lymph nodes were harvested, and a mean 2.6, 5, and 9 metastatic nodes were identified, respectively (p < 0.001), a finding that is proportional to the cancer stage (tau-b = 0.284, p < 0.001; rho = 0.3, p < 0.001). The 5-year disease-free survival rate did not differ among the three groups; however, the LNM3 group had the poorest overall and cancer-specific survival rates. Risk factors associated with cancer-specific survival rate were identified with neural invasion, poorly differentiated tumors, and the location of pathologic lymph nodes (LNM).

Conclusion

Metastatic lymph node location affects oncologic outcomes of stage III colon cancer. The patients for LNM3 metastasis should receive a more aggressive adjuvant treatment.

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References

  1. Heald R (1995) Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus. Br J Surg 82:1297–1299

    Article  CAS  PubMed  Google Scholar 

  2. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Color Dis 11:354–364

    Article  CAS  Google Scholar 

  3. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP (2017) The eighth edition AJCC Cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67:93–99

    Article  PubMed  Google Scholar 

  4. Gospodarowicz MK, Brierley JD, Wittekind C (2017) TNM classification of malignant tumours. Wiley, Hoboken

    Google Scholar 

  5. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441

    Article  PubMed  Google Scholar 

  6. Märkl B (2015) Stage migration vs immunology: the lymph node count story in colon cancer. World J Gastroenterol 21:12218

    Article  PubMed  PubMed Central  Google Scholar 

  7. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H (2015) Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20:207–239

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kwak HD, Ju JK, Lee SY, Kim CH, Kim YJ, Kim HR (2017) A comparison of laparoscopic and open D3 lymphadenectomy for transverse colon cancer. Int J Color Dis 32:1733–1739

    Article  Google Scholar 

  9. Kim J, Lee K, Yu C, Kim H, Kim J, Chang H, Kim J, Kim J, Kim T (2004) The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer. Eur J Surg Oncol 30:271–279

    Article  CAS  PubMed  Google Scholar 

  10. Huh JW, Kim YJ, Kim HR (2012) Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg 255:70–78

    Article  PubMed  Google Scholar 

  11. Wong JH, Bowles BJ, Bueno R, Shimizu D (2002) Impact of the number of negative nodes on disease-free survival in colorectal cancer patients. Dis Colon rectum 45:1341–1348

    Article  PubMed  Google Scholar 

  12. Joseph NE, Sigurdson ER, Hanlon AL, Wang H, Mayer RJ, MacDonald JS, Catalano PJ, Haller DG (2003) Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Oncol 10:213–218

    Article  PubMed  Google Scholar 

  13. Chen SL, Bilchik AJ (2006) More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 244:602

    PubMed  PubMed Central  Google Scholar 

  14. Johnson PM, Porter GA, Ricciardi R, Baxter NN (2006) Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol 24:3570–3575

    Article  PubMed  Google Scholar 

  15. Schumacher P, Dineen S, Barnett C, Fleming J, Anthony T (2007) The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg 194:827–832

    Article  PubMed  Google Scholar 

  16. Rosenberg R, Friederichs J, Schuster T, Gertler R, Maak M, Becker K, Grebner A, Ulm K, Höfler H, Nekarda H (2008) Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3026 patients over a 25-year time period. Ann Surg 248:968–978

    Article  PubMed  Google Scholar 

  17. Lykke J, Roikjær O, Jess P, Group DCC (2013) The relation between lymph node status and survival in S tage I–III colon cancer: results from a prospective nationwide cohort study. Color Dis 15:559–565

    Article  CAS  Google Scholar 

  18. Destri GL, Di Carlo I, Scilletta R, Scilletta B, Puleo S (2014) Colorectal cancer and lymph nodes: the obsession with the number 12. World J Gastroenterol 20:1951–1960

    Article  Google Scholar 

  19. Ong ML, Schofield JB (2016) Assessment of lymph node involvement in colorectal cancer. World J Gastrointest Surg 8:179–192

    Article  PubMed  PubMed Central  Google Scholar 

  20. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Chonnam National University Hospital, 42 Jaebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea

    Han Deok Kwak & Jae Kyun Ju

  2. Department of Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea

    Soo Young Lee, Chang Hyun Kim, Young Jin Kim & Hyeong Rok Kim

Authors
  1. Han Deok Kwak
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  2. Jae Kyun Ju
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  3. Soo Young Lee
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  4. Chang Hyun Kim
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  5. Young Jin Kim
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  6. Hyeong Rok Kim
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Contributions

Study conception and design: H D K and H R K. Acquisition of data: H D K, J K J, S Y L, C H K, Y J K, and H R K. Analysis and interpretation of data: H D K, J K J, S Y L, C H K, Y J K, and H R K. Drafting the article or revising it critically for important intellectual content: H D K, J K J, S Y L, C H K, Y J K, and H R K. Final approval of the version to be published: H D K and H R K.

Corresponding author

Correspondence to Hyeong Rok Kim.

Ethics declarations

The study was approved by the Institutional Review Board of Chonnam National University Hospital (CNUH-2018-159).

Conflict of interest

The authors declare that they have no conflict of interest.

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Colon cancers are staged by assessing more than 12 lymph nodes, but there is still a controversy over the number of lymph nodes. The authors have classified metastatic lymph nodes into D1, D2, and D3 groups and compared the short- and long-term outcomes following laparoscopic colonic resection and radical lymphadenectomy. The number of metastatic nodes was proportional with the stage, and principal (D3) node metastasis showed the lowest overall and cancer-specific survival.

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Kwak, H.D., Ju, J.K., Lee, S.Y. et al. The relation between oncologic outcomes and metastatic lymph node location following laparoscopic resection of stage III colon cancer. Int J Colorectal Dis 34, 667–673 (2019). https://doi.org/10.1007/s00384-019-03245-x

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  • DOI: https://doi.org/10.1007/s00384-019-03245-x

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