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Mesenteric lymph node spread and optimal lymph node resection in colon cancer

Olofsson, Fredrik LU (2016) In Lund University Faculty of Medicine Doctoral Dissertation Series 2016:42.
Abstract
Introduction

Colon cancer is one of the most common forms of cancer world wide, with an incidence of almost 1 million cases anually. Surgery is a prerequisite for cure and the majority of patients are potentially curable at diagnosis. For a surgical resection to be curative the surgeon needs to remove the tumour together with all affected regional lymph nodes. How extensive the mesenteric resection has to be to ensure optimal survival and oncological results is under debate. International standardization of colon cancer surgery is warranted. The two contenders as future “gold standard” for colon cancer surgery are CME with CVL and Japanese D3 resection.

Aim

The aim of this thesis was to evaluate the impact of... (More)
Introduction

Colon cancer is one of the most common forms of cancer world wide, with an incidence of almost 1 million cases anually. Surgery is a prerequisite for cure and the majority of patients are potentially curable at diagnosis. For a surgical resection to be curative the surgeon needs to remove the tumour together with all affected regional lymph nodes. How extensive the mesenteric resection has to be to ensure optimal survival and oncological results is under debate. International standardization of colon cancer surgery is warranted. The two contenders as future “gold standard” for colon cancer surgery are CME with CVL and Japanese D3 resection.

Aim

The aim of this thesis was to evaluate the impact of mesenteric resection and lymph node evaluation on survival in colon cancer. The aim of Paper I to IV was to:

• Examine the impact of the introduction of a standardised pathological and anatomical (PAD) protocol on the quality of pathology and lymph node count.

• Investigate if extended mesenteric resection in right-sided colon cancer improve long term survival and oncological results in a retrospective study.

• Assess the impact of the extent of the mesenteric resection in right-sided colon cancer on long term survival, perioperative mortality and oncological outcome

• Assess oncological outcome, survival and perioperative morbidity and mortality in sigmoid cancer depending on the height of the vessel ligation.

Conclusions

The quality of the PAD-report was improved by introduction of a standardised PAD protocol. Specimen dissection by a BMA increased the number of examined lymph nodes, improving the quality of pathology and possibly outcome.

Extended mesenteric resection, in elective right hemicolectomy, did not improve survival or oncological outcome for cancer in the caecum or ascending colon. Instead extended mesenteric resection may increase 30 day postoperative mortality.

For cancer in the sigmoid colon no survival benefit or decreased recurrence rate was found by more central ligation (HT) compared with ligation of the superior rectal (SRL) or sigmoid vessels (SR), in elective surgery.

Our results question the routine use of extensive mesenteric resection in surgery of the right- and sigmoid colon and instead advocate a flexible surgical response guided by a deeper understanding of the tumor biology behind colon cancer. (Less)
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author
supervisor
opponent
  • Professor Kennedy, Robin, St Marks Hospital, Imperial Collage, London, England
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Colon cancer, lymph node, right hemicolectomy, inferior mesenteric artery, CME
in
Lund University Faculty of Medicine Doctoral Dissertation Series
volume
2016:42
pages
63 pages
publisher
Surgery Research Unit
defense location
Lilla Aulan, MFC, Jan Waldenströmsgata 5, Skånes Universitetssjukhus i Malmö
defense date
2016-04-01 13:00
ISSN
1652-8220
ISBN
978-91-7619-268-9
language
English
LU publication?
yes
id
e8bb29b8-3d05-4755-a710-17e74bd5d3f6 (old id 8852478)
date added to LUP
2016-03-15 13:18:33
date last changed
2016-09-19 08:44:47
@phdthesis{e8bb29b8-3d05-4755-a710-17e74bd5d3f6,
  abstract     = {Introduction <br/><br>
Colon cancer is one of the most common forms of cancer world wide, with an incidence of almost 1 million cases anually. Surgery is a prerequisite for cure and the majority of patients are potentially curable at diagnosis. For a surgical resection to be curative the surgeon needs to remove the tumour together with all affected regional lymph nodes. How extensive the mesenteric resection has to be to ensure optimal survival and oncological results is under debate. International standardization of colon cancer surgery is warranted. The two contenders as future “gold standard” for colon cancer surgery are CME with CVL and Japanese D3 resection.<br/><br>
Aim<br/><br>
The aim of this thesis was to evaluate the impact of mesenteric resection and lymph node evaluation on survival in colon cancer. The aim of Paper I to IV was to:<br/><br>
•	Examine the impact of the introduction of a standardised pathological and anatomical (PAD) protocol on the quality of pathology and lymph node count. <br/><br>
•	Investigate if extended mesenteric resection in right-sided colon cancer improve long term survival and oncological results in a retrospective study.<br/><br>
•	Assess the impact of the extent of the mesenteric resection in right-sided colon cancer on long term survival, perioperative mortality and oncological outcome<br/><br>
•	Assess oncological outcome, survival and perioperative morbidity and mortality in sigmoid cancer depending on the height of the vessel ligation.<br/><br>
Conclusions<br/><br>
The quality of the PAD-report was improved by introduction of a standardised PAD protocol. Specimen dissection by a BMA increased the number of examined lymph nodes, improving the quality of pathology and possibly outcome. <br/><br>
Extended mesenteric resection, in elective right hemicolectomy, did not improve survival or oncological outcome for cancer in the caecum or ascending colon. Instead extended mesenteric resection may increase 30 day postoperative mortality.<br/><br>
For cancer in the sigmoid colon no survival benefit or decreased recurrence rate was found by more central ligation (HT) compared with ligation of the superior rectal (SRL) or sigmoid vessels (SR), in elective surgery.<br/><br>
Our results question the routine use of extensive mesenteric resection in surgery of the right- and sigmoid colon and instead advocate a flexible surgical response guided by a deeper understanding of the tumor biology behind colon cancer.},
  author       = {Olofsson, Fredrik},
  isbn         = {978-91-7619-268-9},
  issn         = {1652-8220},
  keyword      = {Colon cancer,lymph node,right hemicolectomy,inferior mesenteric artery,CME},
  language     = {eng},
  pages        = {63},
  publisher    = {Surgery Research Unit},
  school       = {Lund University},
  series       = {Lund University Faculty of Medicine Doctoral Dissertation Series},
  title        = {Mesenteric lymph node spread and optimal lymph node resection in colon cancer},
  volume       = {2016:42},
  year         = {2016},
}