Advertisement

International Journal of Colorectal Disease

, Volume 30, Issue 6, pp 813–820 | Cite as

Influence of extent of lymph node dissection on survival for patients with pT2 colon cancer

  • Kenjiro Kotake
  • Hirotoshi Kobayashi
  • Michio Asano
  • Heita Ozawa
  • Kenichi Sugihara
Original Article

Abstract

Purpose

The optimal extent of lymph node dissection for early-stage colon cancer (CC) remains undefined. This study assessed the influence of the extent of lymph node dissection on overall survival (OS) in patients with pT2 CC.

Methods

We retrospectively examined data from the multi-institutional registry system of the Japanese Society for Cancer of the Colon and Rectum and used a propensity score matching method to balance potential confounders of lymph node dissection. We extracted 463 matched pairs from 1433 patients who underwent major resections for pT2 CC between 1995 and 2004.

Results

Lymph node metastasis was found in 301 (21.0 %) of 1433 patients with pT2 CC. In this cohort, significant independent risk factors for lymph node metastasis were lymphatic invasion and venous invasion. Patients who underwent D3 or D2 lymph node dissection did not significantly differ in OS, either among the propensity score-matched cohort (estimated hazard ratio [HR] 0.85, 95 % confidence interval [CI] 0.536–1.346, P = 0.484) or in the cohort as a whole (HR 0.720, 95 % CI 0.492–1.052, P = 0.089).

Conclusions

For patients with pT2 CC, D3 lymph node dissection did not add to OS. D2 lymph node dissection may be adequate for pT2 CC.

Keywords

pT2 colon cancer Lymph node metastasis Lymph node dissection Overall survival Propensity score matching 

Notes

Ethical statement

This study was considered exempt by the Tochigi Cancer Center’s institutional review board because it used preexisting data without personal identifiers.

Conflict of interest

None.

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(12):2893–2917. doi: 10.1002/ijc.25516 CrossRefPubMedGoogle 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(2):139–147. doi: 10.1093/jjco/hyr184, Epub 2011 Dec 15CrossRefPubMedGoogle Scholar
  3. 3.
    Kotake K, Honjo S, Sugihara K, Kato T, Kodaira S, Takahashi T, Yasutomi M, Muto T, Koyama Y (2003) Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer. Japan Dis Colon Rectum 46(10 Suppl):S32–S43Google Scholar
  4. 4.
    Bhangu A, Brown G, Nicholls RJ, Wong J, Darzi A, Tekkis P (2013) Survival outcome of local excision versus radical resection of colon or rectal carcinoma: a Surveillance, Epidemiology, and End Results (SEER) population-based study. Ann Surg 258(4):563–569. doi: 10.1097/SLA.0b013e3182a4e85a, discussion 569–71PubMedGoogle Scholar
  5. 5.
    Stamos MJ, Murrell Z (2007) Management of early rectal T1 and T2 cancers. Clin Cancer Res 13(22 Pt 2):6885s–6889sCrossRefPubMedGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network (2015) Clinical practice guidelines in oncology. Colon cancer version 2. NCCN.org. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf (Accessed December, 2014)
  7. 7.
    Watanabe T, Itabashi M, Shimada Y, Japanese Society for Cancer of the Colon and Rectum et al (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17(1):1–29. doi: 10.1007/s10147-011-0315-2 CrossRefPubMedGoogle Scholar
  8. 8.
    Bardakcioglu O, Khan A, Aldridge C, Chen J (2013) Growth of laparoscopic colectomy in the United States: analysis of regional and socioeconomic factors over time. Ann Surg 258(2):270–274. doi: 10.1097/SLA.0b013e31828faa66 CrossRefPubMedGoogle Scholar
  9. 9.
    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):354–364. doi: 10.1111/j.1463-1318.2008.01735.x, discussion 364–5CrossRefPubMedGoogle Scholar
  10. 10.
    Kotake K, Mizuguchi T, Moritani K, Wada O, Ozawa H, Oki I, Sugihara K (2014) Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. Int J Colorectal Dis 29(7):847–852. doi: 10.1007/s00384-014-1885-z CrossRefPubMedGoogle Scholar
  11. 11.
    Japanese Society for Cancer of the Colon and Rectum (1997) Japanese Classification of Colorectal Carcinoma. 1st English edition. Kanehara & Co., Ltd, TokyoGoogle Scholar
  12. 12.
    Hida J, Okuno K, Yasutomi M, Yoshifuji T, Uchida T, Tokoro T, Shiozaki H (2005) Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery: the influence of the site of the primary feeding artery. Dis Colon Rectum 48(12):2232–2237CrossRefPubMedGoogle Scholar
  13. 13.
    Huh JW, Kim HR, Kim YJJ (2010) Lymphovascular or perineural invasion may predict lymph node metastasis in patients with T1 and T2 colorectal cancer. Gastrointest Surg 14(7):1074–1080. doi: 10.1007/s11605-010-1206-y CrossRefGoogle Scholar
  14. 14.
    Fang WL, Chang SC, Lin JK, Wang HS, Yang SH, Jiang JK, Chen WC, Lin TC (2005) Metastatic potential in T1 and T2 colorectal cancer. Hepatogastroenterology 52(66):1688–1691PubMedGoogle Scholar
  15. 15.
    Kajiwara Y, Ueno H, Hashiguchi Y, Mochizuki H, Hase K (2010) Risk factors of nodal involvement in T2 colorectal cancer. Dis Colon Rectum 53(10):1393–1399. doi: 10.1007/DCR.0b013e3181ec5f66 CrossRefPubMedGoogle Scholar
  16. 16.
    Rosi PA, Cahill WJ, Carey J (1962) A ten year study of hemicolectomy in the treatment of carcinoma of the left half of the colon. Surg Gynecol Obstet 114:15–24PubMedGoogle Scholar
  17. 17.
    Grinnell RS (1965) Results of ligation of inferior mesenteric artery at the aorta in resections of carcinoma of the descending and sigmoid colon and rectum. Surg Gynecol Obstet 120:1031–1036PubMedGoogle Scholar
  18. 18.
    Slanetz CA Jr, Grimson R (1997) Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum 40(10):1205–1218CrossRefPubMedGoogle Scholar
  19. 19.
    Kobayashi Y, Fujita S, Yamaguchi T, Yamamoto S, Akasu T, Moriya Y (2009) Optimum lymph node dissection in clinical T1 and clinical T2 colorectal cancer. Dis Colon Rectum 52(5):942–949. doi: 10.1007/DCR.0b013e3181a4f85d CrossRefPubMedGoogle Scholar
  20. 20.
    Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, Brown G, Tudyka V, D’Hoore A, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 29(4):419–428. doi: 10.1007/s00384-013-1818-2 CrossRefPubMedGoogle Scholar
  21. 21.
    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):3109–3116. doi: 10.1200/JCO.2008.20.6771 CrossRefPubMedGoogle Scholar
  22. 22.
    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(8):1171–1178. doi: 10.1002/bjs.7518 CrossRefPubMedGoogle Scholar
  23. 23.
    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):29–35. doi: 10.1093/jjco/hyr164 CrossRefPubMedGoogle Scholar
  24. 24.
    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):219–225CrossRefPubMedGoogle Scholar
  25. 25.
    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):213–218CrossRefPubMedGoogle Scholar
  26. 26.
    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):65–71CrossRefPubMedGoogle Scholar
  27. 27.
    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):2912–2919CrossRefPubMedGoogle Scholar
  28. 28.
    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):60–70. doi: 10.1200/JCO.2011.36.9504 CrossRefPubMedGoogle Scholar
  29. 29.
    Faerden AE, Sjo OH, Bukholm IR, Andersen SN, Svindland A, Nesbakken A, Bakka A (2011) Lymph node micrometastases and isolated tumor cells influence survival in stage I and II colon cancer. Dis Colon Rectum 54(2):200–206. doi: 10.1007/DCR.0b013e3181fd4c7c CrossRefPubMedGoogle Scholar
  30. 30.
    Lips DJ, Koebrugge B, Liefers GJ, van de Linden JC, Smit VT, Pruijt HF, Putter H, van de Velde CJ, Bosscha K (2011) The influence of micrometastases on prognosis and survival in stage I-II colon cancer patients: the Enroute study. BMC Surg 11:11. doi: 10.1186/1471-2482-11-11 CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Maggard MA, Yermilov I, Tomlinson JS, Ko CY (2009) Are 12 nodes needed to accurately stage T1 and T2 colon cancers? Dig Dis Sci 54(3):640–647. doi: 10.1007/s10620-008-0373-0 CrossRefPubMedGoogle Scholar
  32. 32.
    Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimoto H (2014) Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 20(45):16964–16975CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Nakafusa Y, Tanaka T, Kitajima Y, Sato S, Hirohashi Y, Miyazaki K (2004) Modification of lymph node dissection for colon cancer by clinical diagnosis. Hepatogastroenterology 51(57):722–726PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryTochigi Cancer CenterUtsunomiyaJapan
  2. 2.Department of Surgical Oncology, Graduate SchoolTokyo Medical and Dental UniversityTokyoJapan
  3. 3.Department of SurgeryAsano ClinicHamamatsuJapan

Personalised recommendations