Abstract
PURPOSE: The extent of lymph node dissection optimal for the prognosis of right colon cancer is investigated. METHODS: Between 1946 and 1991, 275 patients had curative operation for right colon cancer. A retrospective analysis of rate and degree of lymph node metastasis was performed in each of the 275 patients, and survival rate was estimated in 197 patients who could be followed over a period of three years or more. RESULTS: In most of the curative operative cases of right colon cancer, metastasis to epicolic and paracolic nodes was restricted up to 10 cm proximal or distal to the tumor margin, and metastasis in the central direction was restricted up to main nodes. When cancer metastasized to infrapyloric lymph nodes, dissection of the nodes resulted in a higher rate of long-term prognosis. The five-year cumulative survival rates showed no statistically significant difference between any two of the N0 to N3 lymph node metastasis groups. CONCLUSION: The dissection procedure for right colon cancer involved removal of 10 cm of normal bowel both proximal and distal to the lesion and, in the central direction, dissection of regional lymph nodes along the main trunk artery up to main nodes,i.e., nodes situated anterior to the surgical trunk, which was confirmed to have a therapeutically satisfactory benefit. Infrapyloric lymph nodes must be dissected when metastasis to the nodes is suspected. In cases of cecal or ascending colon cancer in which the middle colic artery is no longer the main trunk artery, a right hemicolectomy with resection of only the right branch of the middle colic artery will usually suffice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jinnai D. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Jpn J Surg 1983;13:557–73.
Gillot C, Hureau J, Aaron C, Martini R, Thaler G. The superior mesenteric vein. Int Surg 1964;41:339–69.
Takahashi T, Mori T, Moossa AR. Tumors of the colon and rectum: clinical features and surgical management. In: Moossa AR, Stephan CS, Martin CR, eds. Comprehensive textbook of oncology. 2nd ed. Baltimore: Williams & Wilkins, 1991:904–33.
Jamieson JK, Dobson JF. The lymphatics of the colon. Ann Surg 1909;1:1077–90.
Jamieson JK, Dobson JF. The lymphatics of the colon. J R Soc Med 1909;2:149–74.
Gilchrist RK, David VC. A consideration of pathological factors influencing five year survival in radical resection of the large bowel and rectum for carcinoma. Ann Surg 1947;126:421–38.
Grinnel RS. Lymphatic block with atypical and retrograde lymphatic metastasis and spread in carcinoma of the colon and rectum. Ann Surg 1966;163:272–80.
Goligher JC. Surgery of the anus, rectum and colon. 5th ed. London: Bailliere Tindall, 1984.
Block GE, Moossa AR, eds. Operative colorectal surgery. Philadelphia: WB Saunders, 1994.
Slanetz CA Jr, Herter FP. The large intestine. In: Haagensen CD, Feind CR, Herter FP, Slanetz CA Jr, Weinberg JA, eds. The lymphatics in cancer. Philadelphia: WB Saunders, 1972:489–568.
Koyama Y, Kokubu K. End results of large bowel cancer in Japan. Rinsho-Geka 1992;47:1123–9.
Susan G, Wieand HS, Moertel CG,et al. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surgery 1992;174:27–32.
Satoh K, Satoh T. Lymphatics of the colon. Shujutsu 1991;45:1341–53.
Author information
Authors and Affiliations
About this article
Cite this article
Toyota, S., Ohta, H. & Anazawa, S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38, 705–711 (1995). https://doi.org/10.1007/BF02048026
Issue Date:
DOI: https://doi.org/10.1007/BF02048026