Advertisement

International Journal of Colorectal Disease

, Volume 29, Issue 7, pp 847–852 | Cite as

Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer

  • Kenjiro Kotake
  • Tomoka Mizuguchi
  • Konosuke Moritani
  • Osamu Wada
  • Heita Ozawa
  • Izumi Oki
  • Kenichi Sugihara
Original Article

Abstract

Purpose

The clinical significance of D3 lymph node dissection for patients with colon cancer remains controversial. This study aims to clarify the impact of D3 lymph node dissection on survival in patients with colon cancer.

Methods

This is a retrospective cohort study from a prospectively registered multi-institutional database of colorectal cancer in Japan. Propensity score matching method was applied to balance potential confounders of the treatment. A cohort of 10,098 patients who underwent radical colectomy for pT3 and pT4 colon cancer between 1985 and 1994 were identified. A total of 3,425 propensity score matched pairs were extracted from the entire cohort. The primary outcome measure was overall survival (OS).

Results

In the entire cohort, there was a statistically significant difference in overall survival (OS) between the patients who had D3 and D2 lymph node dissection (p = 0.00003). The estimated hazard ratio (HR) for OS of patients who had D3 versus D2 lymph node dissection was 0.827 (95 % confidence interval, 0.757 to 0.904). In the matched cohort, there was also a significant difference in OS between the two groups (p = 0.0001), and the estimated HR for OS was 0.814 (95 % confidence interval, 0.734 to 0.904).

Conclusions

We found D3 lymph node dissection for pT3 and pT4 colon cancer to be associated with a significant survival advantage in a large-scale database, even after adjusting potential confounders of lymph node dissection. This finding may provide a rationale for D3 lymph node dissection in radical surgery for pT3 and pT4 colon cancer.

Keywords

Colon cancer D3 lymph node dissection Overall survival Propensity score matching 

Notes

Ethical statement

This study was exempted from review by the Tochigi Cancer Center’s institutional review board, because it used pre-existing data with no personal identifiers.

Conflict of interest

None declared.

References

  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917PubMedCrossRefGoogle Scholar
  2. 2.
    Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, Japan Cancer Surveillance Research Group (2012) Cancer incidence and incidence rates in Japan in 2006: based on data from 15 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 42:139–147PubMedCrossRefGoogle Scholar
  3. 3.
    Quasar Collaborative Group, Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370(9604):2020–2029PubMedCrossRefGoogle Scholar
  4. 4.
    André T, Boni C, Navarro M, Tabernero J, Hickish T, Topham C, Bonetti A, Clingan P, Bridgewater J, Rivera F, de Gramont A (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27(19):3109–3116PubMedCrossRefGoogle Scholar
  5. 5.
    Yothers G, O’Connell MJ, Allegra CJ, Kuebler JP, Colangelo LH, Petrelli NJ, Wolmark N (2011) Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol 29(28):3768–3774PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    National Cancer Center, Center for Cancer Control and Information Services: the national database of hospital-based cancer registry in Japan. (in Japanese) http://ganjoho.jp/professional/statistics/hosp_c_registry.html. Accessed 20 January 2014
  7. 7.
    Gospodarowicz MK, O’Sullivan B, Sobin LH (eds) (2006) Prognostic factors in cancer, 3rd edn. John Wiley & Sons, Inc, HobokenGoogle Scholar
  8. 8.
    Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97(3):219–225PubMedCrossRefGoogle Scholar
  9. 9.
    Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21(15):2912–2919PubMedCrossRefGoogle Scholar
  10. 10.
    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(3):213–218PubMedCrossRefGoogle Scholar
  11. 11.
    Swanson RS, Compton CC, Stewart AK, Bland KI (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10(1):65–71PubMedCrossRefGoogle Scholar
  12. 12.
    Kotake K, Honjo S, Sugihara K, Hashiguchi Y, Kato T, Kodaira S, Muto T, Koyama Y (2012) Number of lymph nodes retrieved is an important determinant of survival of patients with stage II and stage III colorectal cancer. Jpn J Clin Oncol 42(1):29–35PubMedCrossRefGoogle Scholar
  13. 13.
    Miller EA, Woosley J, Martin CF, Sandler RS (2004) Hospital-to-hospital variation in lymph node detection after colorectal resection. Cancer 101(5):1065–1071PubMedCrossRefGoogle Scholar
  14. 14.
    Japanese Society for Cancer of the Colon and Rectum (2009) Japanese classification of colorectal carcinoma. Second English ed. Kanehara-& Co., Ltd., TokyoGoogle Scholar
  15. 15.
    Jamieson JK, Dobson JF (1909) The lymphatics of the colon. Proc R Soc Med 2:149–174PubMedCentralPubMedGoogle Scholar
  16. 16.
    Grinnell RS (1950) Lymphatic metastases of carcinoma of the colon and rectum. Ann Surg 131(4):494–506PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Grinnell RS (1966) Lymphatic block with atypical and retrograde lymphatic metastasis and spread in carcinoma of the colon and rectum. Ann Surg 163(2):272–280PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Cady B (1997) Basic principles in surgical oncology. Arch Surg 132(4):338–346PubMedCrossRefGoogle Scholar
  19. 19.
    Hohenberger W, Reingruber B, Merkel S (2003) Surgery for colon cancer. Scand J Surg 92(1):45–52PubMedGoogle Scholar
  20. 20.
    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. Colorectal Dis 11(4):354–364PubMedCrossRefGoogle Scholar
  21. 21.
    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(15):1763–1769PubMedCrossRefGoogle Scholar
  22. 22.
    Kanemitsu Y, Komori K, Kimura K, Kato T (2013) D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum 56(7):815–824PubMedCrossRefGoogle Scholar
  23. 23.
    Coller FA, Kay EB, Macintyre RS (1941) Regional lymphatic metastases of carcinoma of the colon. Ann Surg 114(1):56–67PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    van der Zaag ES, Bouma WH, Tanis PJ, Ubbink DT, Bemelman WA, Buskens CJ (2012) Systematic review of sentinel lymph node mapping procedure in colorectal cancer. Ann Surg Oncol 19(11):3449–3459PubMedCrossRefGoogle Scholar
  25. 25.
    Sirop S, Kanaan M, Korant A, Wiese D, Eilender D, Nagpal S, Arora M, Singh T, Saha S (2011) Detection and prognostic impact of micrometastasis in colorectal cancer. J Surg Oncol 103(6):534–537PubMedCrossRefGoogle Scholar
  26. 26.
    Rahbari NN, Bork U, Motschall E, Thorlund K, Büchler MW, Koch M, Weitz J (2012) Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol 30(1):60–70PubMedCrossRefGoogle Scholar
  27. 27.
    Watanabe T, Itabashi M, Shimada Y et al (2012) Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17(1):1–29PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kenjiro Kotake
    • 1
  • Tomoka Mizuguchi
    • 1
  • Konosuke Moritani
    • 1
  • Osamu Wada
    • 1
  • Heita Ozawa
    • 1
  • Izumi Oki
    • 2
  • Kenichi Sugihara
    • 3
  1. 1.Department of Colorectal SurgeryTochigi Cancer CenterUtsunomiyaJapan
  2. 2.Epidemiology UnitTochigi Cancer Center Research InstituteUtsunomiyaJapan
  3. 3.Department of Surgical Oncology, Graduate SchoolTokyo Medical and Dental UniversityBunkyo-kuJapan

Personalised recommendations