Top

International Journal of Colorectal Disease

Published in:

01-06-2015 | Original Article

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

Authors: Kenjiro Kotake, Hirotoshi Kobayashi, Michio Asano, Heita Ozawa, Kenichi Sugihara

Published in: International Journal of Colorectal Disease | Issue 6/2015

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.

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 CrossRefPubMed

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 15CrossRefPubMed

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–S43

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 569–71PubMed

Stamos MJ, Murrell Z (2007) Management of early rectal T1 and T2 cancers. Clin Cancer Res 13(22 Pt 2):6885s–6889sCrossRefPubMed

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)

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 CrossRefPubMed

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 CrossRefPubMed

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 364–5CrossRefPubMed

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 CrossRefPubMed

11.

Japanese Society for Cancer of the Colon and Rectum (1997) Japanese Classification of Colorectal Carcinoma. 1st English edition. Kanehara & Co., Ltd, Tokyo

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):2232–2237CrossRefPubMed

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 CrossRef

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):1688–1691PubMed

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 CrossRefPubMed

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 114:15–24PubMed

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 120:1031–1036PubMed

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):1205–1218CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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):219–225CrossRefPubMed

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):213–218CrossRefPubMed

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):65–71CrossRefPubMed

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):2912–2919CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedCentralPubMed

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 CrossRefPubMed

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):16964–16975CrossRefPubMedCentralPubMed

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):722–726PubMed

Title: Influence of extent of lymph node dissection on survival for patients with pT2 colon cancer
Authors: Kenjiro Kotake
Hirotoshi Kobayashi
Michio Asano
Heita Ozawa
Kenichi Sugihara
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 6/2015
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-015-2194-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2015

Prognostic value of CD45RO(+) tumor-infiltrating lymphocytes for locally advanced rectal cancer following 30 Gy/10f neoadjuvant radiotherapy

Long-term effects of a regional care pathway for patients with rectal cancer

Rarity of late anastomotic leakage after low anterior resection of the rectum

A clinical model for predicting lymph node metastasis in submucosal invasive (T1) colorectal cancer

Interactions of the renin-angiotensin system in colorectal cancer and metastasis

Contrast medium at the site of the anastomosis is crucial in detecting anastomotic leakage with CT imaging after colorectal surgery