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The distribution of lymph node metastases and their size in colon cancer

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Abstract

Purpose

The purpose of this study is to clarify the optimal extent of lymph node dissection for colon cancer by evaluating the distributions of lymph node metastases and lymph node size according to tumor location and T stage.

Methods

This study enrolled 662 patients who underwent curative resection for primary colon cancer between 2013 and 2015. Lymph node regions were classified into pericolic, intermediate, and main nodes. The short-axis diameter of each dissected lymph node was measured. The distributions of lymph node metastases and lymph node size were evaluated according to tumor location and T stage.

Results

In the overall cohort, the incidence of metastases in pericolic nodes located more than 5 cm but no more than 10 cm from tumor and in pericolic nodes located more than 10 cm from tumor was 3.6 and 0.2%, respectively. More than 2% of patients with ≥ T2 tumor had metastases in main lymph nodes, and no patients with T1 tumor had metastases in main lymph nodes. Only 0.7% of patients with T1 tumor had lymph node metastases in pericolic nodes located more than 5 cm from the tumor. Both metastatic and non-metastatic lymph node sizes were significantly larger in right-sided colon cancer than in left-sided colon cancer, and both metastatic and non-metastatic lymph node sizes were significantly larger in ≥ T2 tumor than in T1 tumor.

Conclusion

It is necessary to resect 10 cm of normal bowel both proximal and distal to the tumor and to perform D3 lymph node dissection for ≥ T2 colon cancer.

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References

  1. Scholefield JH, Eng C (2014) Colorectal cancer: diagnosis and clinical management. In: Sugihara K, Kinugasa Y, Tsukamoto S (eds) Radical colonic resection, 1st edn. Wiley-Blackwell, New York, pp 87–103

    Google Scholar 

  2. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865

    Article  PubMed  Google Scholar 

  3. 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 discussion 364-365

    Article  CAS  Google Scholar 

  4. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278

    Article  PubMed  Google Scholar 

  5. Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, Arai M, Ueno M (2015) Prognostic impact of distribution of lymph node metastases in stage III colon cancer. World J Surg 39:3008–3015

    Article  PubMed  Google Scholar 

  6. Japanese Society for Cancer of the Colon and Rectum (2009) Japanese classifictaion of colorectal carcinoma, 2nd edn. Kanehara & Co., Tokyo

    Google Scholar 

  7. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D, National Cancer Institute Expert Panel (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596

    Article  CAS  PubMed  Google Scholar 

  8. 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  PubMed  Google Scholar 

  9. Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J, Kubo R, Kitaoka M, Nakamura M, Fujimoto K, Inufusa H, Hatta M, Izumoto G (1994) Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum 37:219–223

    Article  CAS  PubMed  Google Scholar 

  10. Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K (1997) The extent of lymph node dissection for colon carcinoma: the potential impact on laparoscopic surgery. Cancer 80:188–192

    Article  CAS  PubMed  Google Scholar 

  11. Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J (2011) Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 98:1171–1178

    Article  CAS  PubMed  Google Scholar 

  12. Yamaoka Y, Kinugasa Y, Shiomi A, Yamaguchi T, Kagawa H, Yamakawa Y, Furutani A, Numata M (2016) Is it important to palpate lymph nodes in open surgery for colorectal cancer? Asian J Endosc Surg In press

  13. Ishibe A, Ota M, Watanabe J, Suwa Y, Suzuki S, Kanazawa A, Watanabe K, Ichikawa Y, Kunisaki C, Endo I (2016) Prediction of lateral pelvic lymph-node metastasis in low rectal cancer by magnetic resonance imaging. World J Surg 40:995–1001

    Article  PubMed  Google Scholar 

  14. Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H, Colon/Rectum Carcinomas (Primary Tumor) Study Group (2010) Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 53:57–64

    Article  PubMed  Google Scholar 

  15. Jamieson JK, Dobson JF VII (1909) Lymphatics of the colon: with special reference to the operative treatment of cancer of the colon. Ann Surg 50:1077–1090

  16. Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T (1997) Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg 21:109–115

    Article  CAS  PubMed  Google Scholar 

  17. Kanemitsu Y, Hirai T, Komori K, Kato T (2006) Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg 93:609–615

    Article  CAS  PubMed  Google Scholar 

  18. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishihara S, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Boku N, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (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 

  19. Märkl B, Rößle J, Arnholdt HM, Schaller T, Krammer I, Cacchi C, Jähnig H, Schenkirsch G, Spatz H, Anthuber M (2012) The clinical significance of lymph node size in colon cancer. Mod Pathol 25:1413–1422

    Article  PubMed  Google Scholar 

  20. Märkl B, Schaller T, Kokot Y, Endhardt K, Kretsinger H, Hirschbühl K, Aumann G, Schenkirsch G (2016) Lymph node size as a simple prognostic factor in node negative colon cancer and an alternative thesis to stage migration. Am J Surg 212:775–780

    Article  PubMed  Google Scholar 

  21. Mayr P, Aumann G, Schaller T, Schenkirsch G, Anthuber M, Märkl B (2016) Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods. Langenbeck's Arch Surg 401:181–188

    Article  Google Scholar 

  22. Ahmadi O, McCall JL, Stringer MD (2015) Mesocolic lymph node number, size, and density: an anatomical study. Dis Colon Rectum 58:726–735

    Article  PubMed  Google Scholar 

  23. Ahmadi O, Stringer MD, Black MA, McCall JL (2015) Clinico-pathological factors influencing lymph node yield in colorectal cancer and impact on survival: analysis of New Zealand cancer registry data. J Surg Oncol 111:451–458

    Article  PubMed  Google Scholar 

  24. Warschkow R, Sulz MC, Marti L, Tarantino I, Schmied BM, Cerny T, Güller U (2016) Better survival in right-sided versus left-sided stage I–III colon cancer patients. BMC Cancer 16:554

    Article  PubMed  PubMed Central  Google Scholar 

  25. Okada K, Sadahiro S, Suzuki T, Tanaka A, Saito G, Masuda S, Haruki Y (2015) The size of retrieved lymph nodes correlates with the number of retrieved lymph nodes and is an independent prognostic factor in patients with stage II colon cancer. Int J Color Dis 30:1685–1693

    Article  Google Scholar 

  26. Gervaz P, Bucher P, Morel P (2004) Two colons-two cancers: paradigm shift and clinical implications. J Surg Oncol 88:261–266

    Article  PubMed  Google Scholar 

  27. Søreide K, Nedrebø BS, Søreide JA, Slewa A, Kørner H (2009) Lymph node harvest in colon cancer: influence of microsatellite instability and proximal tumor location. World J Surg 33:2695–2703

    Article  PubMed  Google Scholar 

  28. Dhar DK, Yoshimura H, Kinukawa N, Maruyama R, Tachibana M, Kohno H, Kubota H, Nagasue N (2005) Metastatic lymph node size and colorectal cancer prognosis. J Am Coll Surg 200:20–28

    Article  PubMed  Google Scholar 

  29. Hida J, Okuno K, Yasutomi M, Yoshifuji T, Matsuzaki T, Uchida T, Ishimaru E, Tokoro T, Shiozaki H (2005) Number versus distribution in classifying regional lymph node metastases from colon cancer. J Am Coll Surg 201:217–222

    Article  PubMed  Google Scholar 

  30. Kobayashi H, Ueno H, Hashiguchi Y, Mochizuki H (2006) Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer. Surgery 139:516–522

    Article  PubMed  Google Scholar 

  31. Hundt W, Braunschweig R, Reiser M (1999) Evaluation of spiral CT in staging of colon and rectum carcinoma. Eur Radiol 9:78–84

    Article  CAS  PubMed  Google Scholar 

  32. Huh JW, Jeong YY, Kim HR, Kim YJ (2012) Prognostic value of preoperative radiological staging assessed by computed tomography in patients with nonmetastatic colon cancer. Ann Oncol 3:1198–1206

    Article  Google Scholar 

  33. Sloothaak DA, Grewal S, Doornewaard H, van Duijvendijk P, Tanis PJ, Bemelman WA, van der Zaag ES, Buskens CJ (2014) Lymph node size as a predictor of lymphatic staging in colonic cancer. Br J Surg 101:701–706

    Article  CAS  PubMed  Google Scholar 

  34. Mönig SP, Baldus SE, Zirbes TK, Schröder W, Lindemann DG, Dienes HP, Hölscher AH (1999) Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol 6:579–581

    Article  PubMed  Google Scholar 

  35. Hatano S, Ishida H, Ishiguro T, Kumamoto K, Ishibashi K, Mochiki E, Tamaru J (2015) Prediction of metastasis to mesorectal, internal iliac and obturator lymph nodes according to size criteria in patients with locally advanced lower rectal cancer. Jpn J Clin Oncol 45:35–42

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Yusuke Yamaoka, Yusuke Kinugasa, Akio Shiomi, Tomohiro Yamaguchi, Hiroyasu Kagawa, Yushi Yamakawa, Akinobu Furutani & Shoichi Manabe

Authors
  1. Yusuke Yamaoka
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  2. Yusuke Kinugasa
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  3. Akio Shiomi
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  4. Tomohiro Yamaguchi
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  5. Hiroyasu Kagawa
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  6. Yushi Yamakawa
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  7. Akinobu Furutani
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  8. Shoichi Manabe
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Contributions

Yusuke Yamaoka and Yusuke Kinugasa drafted the paper. Yusuke Kinugasa designed this study. Yusuke Yamaoka, Akio Shiomi, Tomohiro Yamaguchi, Hiroyasu Kagawa, Yushi Yamakawa, Akinobu Furutani, and Shoichi Manabe obtained and analyzed data.

Corresponding author

Correspondence to Yusuke Kinugasa.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the institutional review board of Shizuoka Cancer Center Hospital (Institutional code, 28-J89-28-1-3).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Yamaoka, Y., Kinugasa, Y., Shiomi, A. et al. The distribution of lymph node metastases and their size in colon cancer. Langenbecks Arch Surg 402, 1213–1221 (2017). https://doi.org/10.1007/s00423-017-1628-z

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  • DOI: https://doi.org/10.1007/s00423-017-1628-z

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