Prospective analysis of tumor spread to the small bowel mesentery in cases of right-sided colon cancer

Purpose Guidelines advocate minimal ileal resection when right hemicolectomy is performed for right-sided colon cancer. The practice, thought to prevent malabsorption syndrome, does not appear to foster local recurrence. Little evidence based on rigorous study exists, however. To understand the patt...

Full description

Saved in:
Bibliographic Details
Published in:Langenbeck's archives of surgery 2020-12, Vol.405 (8), p.1139-1145
Main Authors: Sato, Sumito, Shiozawa, Manabu, Sugano, Nobuhiro, Higuchi, Akio, Kazama, Keisuke, Kato, Aya, Uchiyama, Mamoru, Okamoto, Hironao, Kohmura, Takashi, Oshima, Takashi, Rino, Yasushi, Masuda, Munetaka
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
General Surgery
Medicine
Medicine & Public Health
Original Article
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Purpose Guidelines advocate minimal ileal resection when right hemicolectomy is performed for right-sided colon cancer. The practice, thought to prevent malabsorption syndrome, does not appear to foster local recurrence. Little evidence based on rigorous study exists, however. To understand the pattern of lymphatic spread of right-sided colon cancer toward the small bowel and thus determine the appropriate margin size, we prospectively investigated anatomical distribution of lymph nodes (LNs) in the small bowel mesentery and of metastasis to these nodes in patients with right-sided colon cancer treated by such surgery. Methods In each case, the mesenteric specimen, which had been dissected along the ileocolic vessels and included intermediate LNs, was divided into 2 areas: that 0–3 cm from the vessel pedicle (area 1) and that 3–5 cm from the pedicle (area 2). The peri-intestinal mesentery was cut into 9 segments. Results Ninety-one patients were included in the study. Overall, 3366 LNs were dissected. Four hundred fifty-three of these LNs were located in area 1 (90 cases), and 15 (3.3%) were metastatic. Only 63 LNs were located in area 2 (34 cases; average of 0.69 per patient); none was metastatic. Overall, 269 LNs were found in the small bowel mesentery (in 56 of the 91 patients). Only 4 were positive (3 cases), and all were within 5 cm of the ileocecal valve. Conclusion Our data indicate that a surgical margin 3 cm from the ileocecal pedicle and a short (5 cm) ileal margin are oncologically reasonable for effective right hemicolectomy.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-020-02016-5