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Factors influencing apical node metastasis in colorectal cancer patients treated with laparoscopic radical resection with D3 lymphadenectomy: results from two centers in China

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Abstract

Purpose

To identify the risk factors for apical node metastasis in colorectal cancer (CRC) patients who underwent laparoscopic radical resection with D3 lymphadenectomy.

Methods

The subjects were 578 consecutive patients who underwent laparoscopic radical resection with D3 lymphadenectomy for CRC between February, 2003 and December, 2009. The Cox proportional regression model was used to evaluate the association between apical node metastasis and survival and the logistic regression model was used to identify the risk factors for apical node metastasis.

Results

Thirty patients (5.2 %) had apical node metastasis, which was an independent risk factor for poor disease-free survival [hazard ratio (HR) = 3.02, P = 0.019]. Multivariate logistic regression analysis revealed that poor differentiation [odds ratio (OR) = 4.58, P < 0.001] and ulcerative/infiltrative morphology (OR = 5.57, P = 0.023) were independent risk factors for apical node metastasis. In the subgroup analysis based on pT3–4 tumors, multivariate logistic regression analysis also suggested that these factors were significantly associated with apical node metastasis.

Conclusions

Apical node metastasis is an independent risk factor for poor oncologic outcome. T3–4 stage, poor differentiation, and ulcerative/infiltrative morphology are significantly associated with apical node metastasis. Notably, in this study, T1–2 stage tumors had no apical node metastasis, suggesting that D3 lymphadenectomy may be over-performed without considering the T stage of tumors.

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References

  1. Gervasoni JE Jr, Taneja C, Chung MA, Cady B. Biologic and clinical significance of lymphadenectomy. Surg Clin N Am. 2000;80:1631–73.

    Article  PubMed  Google Scholar 

  2. Kawamura YJ, Umetani N, Sunami E, Watanabe T, Masaki T, Muto T. Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement. Eur J Surg. 2000;166:803–7.

    Article  CAS  PubMed  Google Scholar 

  3. Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review. Dig Surg. 2008;25:148–57.

    Article  CAS  PubMed  Google Scholar 

  4. Hida J, Okuno K. High ligation of the inferior mesenteric artery in rectal cancer surgery. Surg Today. 2013;43:8–19.

    Article  PubMed  Google Scholar 

  5. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–96.

    Article  CAS  PubMed  Google Scholar 

  6. Mammen JM, James LE, Molloy M, Williams A, Wray CJ, Sussman JJ. The relationship of lymph node dissection and colon cancer survival in the veterans affairs central cancer registry. Am J Surg. 2007;194:349–54.

    Article  PubMed  Google Scholar 

  7. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis. 2009;11:354–64 (discussion 364–355).

    Article  CAS  PubMed  Google Scholar 

  8. Kanemitsu Y, Hirai T, Komori K, Kato T. Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg. 2006;93:609–15.

    Article  CAS  PubMed  Google Scholar 

  9. Slanetz CA Jr, Grimson R. Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum. 1997;40:1205–18 (discussion 1218–1209).

    Article  PubMed  Google Scholar 

  10. Malassagne B, Valleur P, Serra J, Sarnacki S, Galian A, Hoang C, et al. Relationship of apical lymph node involvement to survival in resected colon carcinoma. Dis Colon Rectum. 1993;36:645–53.

    Article  CAS  PubMed  Google Scholar 

  11. Kim JC, Lee KH, Yu CS, Kim HC, Kim JR, Chang HM, et al. The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer. Eur J Surg Oncol. 2004;30:271–9.

    Article  CAS  PubMed  Google Scholar 

  12. Ang CW, Tweedle EM, Campbell F, Rooney PS. Apical node metastasis independently predicts poor survival in Dukes C colorectal cancer. Colorectal Dis. 2011;13:526–31.

    Article  CAS  PubMed  Google Scholar 

  13. Huh JW, Kim YJ, Kim HR. Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg. 2012;255:70–8.

    Article  PubMed  Google Scholar 

  14. Yi JW, Lee TG, Lee HS, Heo SC, Jeong SY, Park KJ, et al. Apical-node metastasis in sigmoid colon or rectal cancer: is it a factor that indicates a poor prognosis after high ligation? Int J Colorectal Dis. 2012;27:81–7.

    Article  PubMed  Google Scholar 

  15. Liang YZ, Yu J, Zhang C, Wang YN, Cheng X, Huang F, et al. Construction and application of evaluation system of laparoscopic colorectal surgery based on clinical data mining. Zhonghua Wei Chang Wai Ke Za Zhi. 2010;13:741–4.

    PubMed  Google Scholar 

  16. Koyama Y, Kotake K. Overview of colorectal cancer in Japan: report from the registry of the Japanese Society for Cancer of the Colon and Rectum. Dis Colon Rectum. 1997;40:S2–9.

    Article  CAS  PubMed  Google Scholar 

  17. Washington MK, Berlin J, Branton PA, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinomas of the colon and rectum. Arch Pathol Lab Med. 2008;132:1182–93.

    PubMed  Google Scholar 

  18. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.

    Article  PubMed  Google Scholar 

  19. Hida J, Okuno K, Yasutomi M, Yoshifuji T, Uchida T, Tokoro T, et al. 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. 2005;48:2232–7.

    Article  PubMed  Google Scholar 

  20. Chin CC, Yeh CY, Tang R, Changchien CR, Huang WS, Wang JY. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer. Int J Colorectal Dis. 2008;23:783–8.

    Article  PubMed  Google Scholar 

  21. Liang JT, Huang KC, Lai HS, Lee PH, Sun CT. Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol. 2007;14:1980–90.

    Article  PubMed  Google Scholar 

  22. Alici A, Kement M, Gezen C, Akin T, Vural S, Okkabaz N, et al. Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer: an analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity. Tech Coloproctol. 2010;14:1–8.

    Article  CAS  PubMed  Google Scholar 

  23. Kang J, Hur H, Min BS, Kim NK, Lee KY. Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer. Ann Surg Oncol. 2011;18:704–10.

    Article  PubMed  Google Scholar 

  24. Yamauchi H, Togashi K, Kawamura YJ, Horie H, Sasaki J, Tsujinaka S, et al. Pathological predictors for lymph node metastasis in T1 colorectal cancer. Surg Today. 2008;38:905–10.

    Article  PubMed  Google Scholar 

  25. Glasgow SC, Bleier JI, Burgart LJ, Finne CO, Lowry AC. Meta-analysis of histopathological features of primary colorectal cancers that predict lymph node metastases. J Gastrointest Surg. 2012;16:1019–28.

    Article  PubMed  Google Scholar 

  26. Chang HC, Huang SC, Chen JS, Tang R, Changchien CR, Chiang JM, et al. Risk factors for lymph node metastasis in pT1 and pT2 rectal cancer: a single-institute experience in 943 patients and literature review. Ann Surg Oncol. 2012;19:2477–84.

    Article  PubMed  Google Scholar 

  27. Choi PW, Yu CS, Jang SJ, Jung SH, Kim HC, Kim JC. Risk factors for lymph node metastasis in submucosal invasive colorectal cancer. World J Surg. 2008;32:2089–94.

    Article  PubMed  Google Scholar 

  28. Seike K, Koda K, Saito N, Oda K, Kosugi C, Shimizu K, et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis. 2007;22:689–97.

    Article  PubMed  Google Scholar 

  29. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1–29.

    Article  PubMed  Google Scholar 

  30. Huh JW, Kim HR, Kim YJ. Lymphovascular or perineural invasion may predict lymph node metastasis in patients with T1 and T2 colorectal cancer. J Gastrointest Surg. 2010;14:1074–80.

    Article  PubMed  Google Scholar 

  31. Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer. World J Surg. 2007;31:1485–90.

    Article  PubMed  Google Scholar 

  32. Gleeson FC, Clain JE, Papachristou GI, Rajan E, Topazian MD, Wang KK, et al. Prospective assessment of EUS criteria for lymphadenopathy associated with rectal cancer. Gastrointest Endosc. 2009;69:896–903.

    Article  PubMed  Google Scholar 

  33. Schwarz RE. Factors influencing change of preoperative treatment intent in a gastrointestinal cancer practice. World J Surg Oncol. 2007;5:32.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Sample CB, Watson M, Okrainec A, Gupta R, Birch D, Anvari M. Long-term outcomes of laparoscopic surgery for colorectal cancer. Surg Endosc. 2006;20:30–4.

    Article  CAS  PubMed  Google Scholar 

  35. Scala A, Huang A, Dowson HM, Rockall TA. Laparoscopic colorectal surgery—results from 200 patients. Colorectal Dis. 2007;9:701–5.

    Article  CAS  PubMed  Google Scholar 

  36. Neudecker J, Klein F, Bittner R, Carus T, Stroux A, Schwenk W, et al. Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg. 2009;96:1458–67.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We gratefully acknowledge the financial support for this project form the National Key Technology R&D Program (Grant Number: 2013BAI05B00), the Program of the National key Clinical Medical Specialty, the Major Program of Science and Technology Program of Guangzhou (Grant Number: 201300000087), and Research Fund of Public welfare in Health Industry (Grant Number: 201402015), 2014, Health Ministry of China.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of General Surgery, Nanfang Hospital, Southern Medical University, North Guangzhou Road 1838, 510515, Guangzhou, China

    Hongyuan Chen, Yanan Wang, Hao Liu, Yanfeng Hu, Liying Zhao & Guoxin Li

  2. Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, China

    Pan Chi

Authors
  1. Hongyuan Chen
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  2. Yanan Wang
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  3. Hao Liu
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  4. Yanfeng Hu
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  5. Liying Zhao
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  6. Guoxin Li
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  7. Pan Chi
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Corresponding authors

Correspondence to Guoxin Li or Pan Chi.

Additional information

H. Chen and Y. Wang contributed equally to this paper.

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Chen, H., Wang, Y., Liu, H. et al. Factors influencing apical node metastasis in colorectal cancer patients treated with laparoscopic radical resection with D3 lymphadenectomy: results from two centers in China. Surg Today 45, 569–575 (2015). https://doi.org/10.1007/s00595-014-1013-2

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  • DOI: https://doi.org/10.1007/s00595-014-1013-2

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