Skip to main content
Top
Published in: Updates in Surgery 2/2024

Open Access 21-01-2024 | Metastasis | Original Article

A nomogram for predicting lymph nodes metastasis at the inferior mesenteric artery in rectal cancer: a retrospective case–control study

Authors: Chunhao Xu, Qiaoyi Huang, Yunhuang Hu, Kai Ye, Jianhua Xu

Published in: Updates in Surgery | Issue 2/2024

Login to get access

Abstract

According to past and current literature, metastasis of the lymph nodes at the inferior mesenteric artery (IMA-LN), also known as 253LN of colorectal cancer has been seldom investigated. To date, there are still controversies on whether the 253LN need to be routinely cleaned. Using specific criteria, 347 patients who underwent radical resection for rectal cancer between April 2019 and July 2022 were selected for the study. Logistic regression was used to determine the likelihood that a patient may suffer 253LN metastasis, and a nomogram for 253LN metastasis subsequently developed. The c-index and calibration curve were used to evaluate precision and discrimination in the nomogram, and the appropriateness of the final nomogram for the clinical setting determined using decision curve analysis (DCA). 253LN metastases appeared in the pathological specimens of 29 (8.4%) of the selected patients. Logistic regression showed that preoperative parameters including serum carcinoembryonic antigen (CEA) value ( > 5 ng / ml, OR = 2.894, P = 0.023), distance from anal margin (> 9 cm, OR = 2.406, P = 0.045) and degree of differentiation (poor, OR = 9.712, P < 0.001) were significantly associated with 253LN metastasis. A nomogram to predict 253LN metastasis in rectal cancer was developed and showed considerable discrimination and good precision (c-index = 0.750). Furthermore, DCA confirmed that the nomogram has some feasibility for the clinical environment. Clinicopathological and radiological patient data can be pivotal for making surgical decisions relating to 253LN metastasis. A nomogram was developed using this data, providing an objective method that can significantly improve prognoses in colorectal cancer.
Literature
2.
go back to reference Munechika T, Kajitani R, Matsumoto Y, Nagano H, Komono A, Aisu N et al (2021) Safety and effectiveness of high ligation of the inferior mesenteric artery for cancer of the descending colon under indocyanine green fluorescence imaging: a Pilot Study. Surg Endoscopy 35(4):1696–1702. https://doi.org/10.1007/s00464-020-07556-xCrossRef Munechika T, Kajitani R, Matsumoto Y, Nagano H, Komono A, Aisu N et al (2021) Safety and effectiveness of high ligation of the inferior mesenteric artery for cancer of the descending colon under indocyanine green fluorescence imaging: a Pilot Study. Surg Endoscopy 35(4):1696–1702. https://​doi.​org/​10.​1007/​s00464-020-07556-xCrossRef
7.
go back to reference Inoue H, Sasaki K, Nozawa H, Kawai K, Murono K, Emoto S et al (2021) Therapeutic significance of D3 dissection for low rectal cancer: a comparison of dissections between the lateral pelvic lymph nodes and the lymph nodes along the root of the inferior mesenteric artery in a multicenter retrospective cohort study. Multicenter Study 36(6):1263–1270. https://doi.org/10.1007/s00384-021-03858-1CrossRef Inoue H, Sasaki K, Nozawa H, Kawai K, Murono K, Emoto S et al (2021) Therapeutic significance of D3 dissection for low rectal cancer: a comparison of dissections between the lateral pelvic lymph nodes and the lymph nodes along the root of the inferior mesenteric artery in a multicenter retrospective cohort study. Multicenter Study 36(6):1263–1270. https://​doi.​org/​10.​1007/​s00384-021-03858-1CrossRef
15.
16.
go back to reference Mari G, Crippa J, Cocozza E, Berselli M, Livraghi L, Carzaniga P et al (2019) Low ligation of inferior mesenteric artery in laparoscopic anterior resection for rectal cancer reduces genitourinary dysfunction: results from a randomized controlled trial (highlow trial). Annal Surg 269(6):1018–1024. https://doi.org/10.1097/sla.0000000000002947CrossRef Mari G, Crippa J, Cocozza E, Berselli M, Livraghi L, Carzaniga P et al (2019) Low ligation of inferior mesenteric artery in laparoscopic anterior resection for rectal cancer reduces genitourinary dysfunction: results from a randomized controlled trial (highlow trial). Annal Surg 269(6):1018–1024. https://​doi.​org/​10.​1097/​sla.​0000000000002947​CrossRef
18.
go back to reference Fujii S, Ishibe A, Ota M, Suwa H, Watanabe J, Kunisaki C et al (2019) Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection subanalysis of the Htlt (high tie vs. low tie) study. Surg Endosc 33(4):1100–1110. https://doi.org/10.1007/s00464-018-6363-1CrossRefPubMed Fujii S, Ishibe A, Ota M, Suwa H, Watanabe J, Kunisaki C et al (2019) Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection subanalysis of the Htlt (high tie vs. low tie) study. Surg Endosc 33(4):1100–1110. https://​doi.​org/​10.​1007/​s00464-018-6363-1CrossRefPubMed
24.
go back to reference He J, Lou Z, Zhang W, Meng R, Fu C, Yu E et al (2015) Analysis of risk factors associate with lymph node metastasis of T1 and T2 rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi 18(10):1016–1019PubMed He J, Lou Z, Zhang W, Meng R, Fu C, Yu E et al (2015) Analysis of risk factors associate with lymph node metastasis of T1 and T2 rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi 18(10):1016–1019PubMed
Metadata
Title
A nomogram for predicting lymph nodes metastasis at the inferior mesenteric artery in rectal cancer: a retrospective case–control study
Authors
Chunhao Xu
Qiaoyi Huang
Yunhuang Hu
Kai Ye
Jianhua Xu
Publication date
21-01-2024
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 2/2024
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-023-01748-5

Other articles of this Issue 2/2024

Updates in Surgery 2/2024 Go to the issue
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare