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Index of estimated benefit from lymph node dissection for stage I–III transverse colon cancer: an analysis of the JSCCR database

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Abstract

Purpose

Main lymph node metastasis (LNM) dissection of transverse colon (TC) cancer is a difficult surgical procedure. Nonetheless, the main LNM ratio and the benefit of main lymph node (LN) dissection in TC cancer were unclear. This study aimed to identify high-risk patients for LNM and to evaluate the benefit of LN dissection in TC cancer.

Methods

Data for 26,552 colorectal cancer patients between 2007 and 2011 were obtained from the JSCCR database. Of these, 871 stage I–III TC cancer patients underwent surgery with radical LN dissection. These patients were evaluated using the index of estimated benefit from lymph node dissection (IEBLD), where IEBLD = (LNM ratio of each LN station) × (5-year overall survival (OS) rate of the patients with LNM) × 100.

Results

None of the patients with depth of invasion pT1–2 had main LNM. The presence of main LNM was associated with depth of invasion pT4, CEA-4H (carcinoembryonic antigen 4 times higher than preoperative cutoff value), or type 3, and 323 patients (37.1%) who had these factors were high-risk patients for main LNM. In these high-risk patients, the LNM ratio, 5-year OS rate of patients with LNM and IEBLD values, respectively, were 43.9%, 70.3%, and 30.5 for the pericolic LN; 20.3%, 66.0%, and 15.1 for the intermediate LN; and 9.6%, 58.5%, and 5.6 for the main LN.

Conclusion

Main LNM is associated with depth of invasion pT4, CEA-4H, or type 3. The IEBLD for the main LN of high-risk TC cancer patients was over 5.

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Acknowledgements

We thank the participants of the JSCCR registry.

Funding

This work was supported by JSPS KAKENHI (grant number 19K09199).

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Hiroshi Sawayama, Yuji Miyamoto, Katsuhiro Ogawa, Mayuko Ohuchi, Ryuma Tokunaga, Naoya Yoshida & Hideo Baba

  2. Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan

    Hirotoshi Kobayashi

  3. Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Hiroshi Sawayama
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  2. Yuji Miyamoto
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  3. Katsuhiro Ogawa
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  5. Ryuma Tokunaga
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  6. Naoya Yoshida
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  7. Hirotoshi Kobayashi
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  8. Kenichi Sugihara
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  9. Hideo Baba
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Contributions

Hiroshi Sawayama contributed to the study concept and design, acquisition of data, analysis and interpretation of the data, drafting of the manuscript, and statistical analysis. Yuji Miyamoto contributed to the study concept and design, acquisition of data, analysis and interpretation of the data, drafting of the manuscript, and statistical analysis. Katsuhiro Ogawa contributed to the analysis and interpretation of the data and drafting of the manuscript. Mayuko Ohuchi contributed to the analysis and interpretation of the data and drafting of the manuscript. Ryuma Tokunaga contributed to the analysis and interpretation of the data and drafting of the manuscript. Naoya Yoshida contributed to the analysis and interpretation of the data and drafting of the manuscript. Hirotoshi Kobayashi contributed to the acquisition of data and analysis and interpretation of the data. Kenichi Sugihara contributed to the critical revision of the manuscript for important intellectual content. Hideo Baba contributed to the study supervision.

Corresponding author

Correspondence to Hideo Baba.

Ethics declarations

Disclosure of ethical statements

Approval of the research protocol: The study protocol was approved by the Institutional Review Board of Kumamoto University, Approval Nos. 2377 and 2378. All the hospitals disclosed information to the patients. The participating patients were excluded only when they specified that they were unwilling to participate. The items of the registry of the study and animal studies are not applicable.

Conflict of interest

The authors declare no competing interests.

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Supplementary information

Supplementary Figure S1.

A. Kaplan–Meier survival curves for patients with depth of invasion pT4 (N= 256) according to the station of lymph node metastasis (LNM): pericolic LNs (A-1), intermediate LNs (A-2) and main LNs (A-3). B. Kaplan–Meier survival curves for patients with CEA-4H (N= 77) according to the station of LNM: pericolic LNs (B-1), intermediate LNs (B-2) and main LNs (B-3). C. Kaplan–Meier survival curves for patients with Type 3 (N= 64) according to the station of LNM: pericolic LNs (C-1), intermediate LNs (C-2) and main LNs (C-3). (PPT 231 kb)

Supplementary Figure S2.

A. Kaplan–Meier survival curve according to adjuvant chemothepray for Stage III TC patients. B. Kaplan–Meier survival curve according to adjuvant chemothepray for theTC patients with main LNM. ACT; adjuvant chemotepray. (PPT 122 kb)

Supplementary Figure S3.

Kaplan–Meier survival curve according to surgical procedure (N=809). Data on surgical procedure were unavailable for 62 patients. (PPT 115 kb)

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Sawayama, H., Miyamoto, Y., Ogawa, K. et al. Index of estimated benefit from lymph node dissection for stage I–III transverse colon cancer: an analysis of the JSCCR database. Langenbecks Arch Surg 407, 2011–2019 (2022). https://doi.org/10.1007/s00423-022-02525-5

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  • DOI: https://doi.org/10.1007/s00423-022-02525-5

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