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Optimal bowel resection margin in colon cancer surgery: prospective multicentre cohort study with lymph node and feeding artery mapping

2023; Elsevier BV; Volume: 33; Linguagem: Inglês

10.1016/j.lanwpc.2022.100680

2666-6065

Hideki Ueno, Kazuo Hase, Akio Shiomi, Manabu Shiozawa, Masaaki Ito, Toshihiko Satō, Yojiro Hashiguchi, Takaya Kusumi, Yusuke Kinugasa, Hideyuki Ike, Kenji Matsuda, Kazutaka Yamada, Koji Komori, Keiichi Takahashi, Yukihide Kanemitsu, Heita Ozawa, Masayuki Ohue, Tadahiko Masaki, Yasumasa Takii, Atsushi Ishibe, Jun Watanabe, Yuji Toiyama, Hiromichi Sonoda, Keiji Koda, Yoshito Akagi, Michio Itabashi, Takahiro Nakamura, Kenichi Sugihara,

Colorectal and Anal Carcinomas

There are no standardised criteria for the 'regional' pericolic node in colon cancer, which represents a major cause of the international uncertainty regarding the optimal bowel resection margin. This study aimed to determine 'regional' pericolic nodes based on prospective lymph node (LN) mapping.According to preplanned in vivo measurements of the bowel, the anatomical distributions of the feeding artery and LNs were determined in 2996 stages I-III colon cancer patients who underwent colectomy with resection margin >10 cm at 25 institutions in Japan.The mean number of retrieved pericolic nodes was 20.9 (standard deviation, 10.8) per patient. In all patients except seven (0.2%), the primary feeding artery was distributed within 10 cm of the primary tumour. The metastatic pericolic node most distant from the primary tumour was within 3 cm in 837 patients, 3-5 cm in 130 patients, 5-7 cm in 39 patients and 7-10 cm in 34 patients. Only four patients (0.1%) had pericolic lymphatic spread beyond 10 cm; all of whom had T3/4 tumours accompanying extensive mesenteric lymphatic spread. The location of metastatic pericolic node did not differ by the feeding artery's distribution. Postoperatively, none of the 2996 patients developed recurrence in the remaining pericolic nodes.The pericolic nodes designated as 'regional' were those located within 10 cm of the primary tumours, which should be fully considered when determining the bowel resection margin, even in the era of complete mesocolic excision.Japanese Society for Cancer of the Colon and Rectum.