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Which is more important in the management of splenic flexure colon cancer: strict central lymph node dissection or adequate bowel resection margin?

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Abstract

Background

What qualifies as optimal lymph node (LN) dissection in the surgical management of splenic flexure colon cancer (SFCC) still remains controversial because few studies have evaluated the distribution of LN metastasis of SFCC. The aim of this study was to clarify detailed distribution of LN metastasis and long-term outcomes of SFCC.

Methods

This retrospective study enrolled patients who had curative colectomy for primary transverse or descending colon cancer of pathological stage I, II, or III at a single high-volume cancer center between April 2002 and December 2018. The 538 eligible patients were divided into three groups: patients with SFCC (SFCC group, n = 168), patients with proximal transverse colon cancer (PTCC group, n = 290), and patients with distal descending colon cancer (DDCC group, n = 80). LNs were classified into horizontal (pericolic) and vertical (intermediate and main) nodes. Intermediate and main LN station numbers were defined according to the Japanese Society for Cancer of the Colon and Rectum classification. Distributions of LN metastasis and long-term outcomes were compared.

Results

In the SFCC group, the mean age was 67.3 ± 10.5 years and 110 patients (65.5%) were male. The proportion of patients with LN metastasis in the intermediate or main region was significantly lower in the SFCC group (8%) than in the PTCC (37%) (p < 0.01) or DDCC group (29%) (p < 0.01) in pathological stage III patients. In the SFCC group, the incidence of pericolic LN metastasis on the oral side of tumor (43%) was significantly higher than in the PTCC group (21%) (p < 0.01) and was similar to that in the DDCC group (42%) (p = 0.51), while in the SFCC group, the incidence of pericolic LN metastasis on the anal side of tumor (17%) was lower than in the PTCC group (31%) and was also similar to that in the DDCC group (21%). There were no significant differences in disease-specific survival rates among all groups.

Conclusions

LN metastasis occurred mainly in the pericolic region, especially on the oral side of the tumor in SFCC. It may, therefore, be important to have an adequate bowel resection margin, especially on the oral side, for SFCC.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Y. Yamaoka, A. Shiomi, H. Kagawa, H. Hino, S. Manabe, S. Kato & M. Hanaoka

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  1. Y. Yamaoka
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  2. A. Shiomi
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  3. H. Kagawa
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  4. H. Hino
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  5. S. Manabe
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  6. S. Kato
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  7. M. Hanaoka
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Contributions

Yusuke Yamaoka drafted the paper and designed this study. Yusuke Yamaoka, Akio Shiomi, Hiroyasu Kagawa, Hitoshi Hino, Shoichi Manabe, Shunichiro Kato, and Marie Hanaoka obtained and analyzed data.

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Correspondence to Y. Yamaoka.

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The authors declare no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the institutional review board of Shizuoka Cancer Center Hospital (Institutional code: J2019-7-2019-1-3).

Informed consent

Written informed consents for examination and treatment were obtained from all patients prior to the procedures.

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Yamaoka, Y., Shiomi, A., Kagawa, H. et al. Which is more important in the management of splenic flexure colon cancer: strict central lymph node dissection or adequate bowel resection margin?. Tech Coloproctol 24, 873–882 (2020). https://doi.org/10.1007/s10151-020-02260-3

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  • DOI: https://doi.org/10.1007/s10151-020-02260-3

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