Skip to main content
Erschienen in: European Surgery 4/2018

18.04.2018 | original article

Impact of anatomical versus non-anatomical resection for stage II and III colon cancer

verfasst von: Tomoya Funada, M.D., Shintaro Yamazaki, M.D., Mitsugu Kochi, M.D., Tadatoshi Takayama, M.D

Erschienen in: European Surgery | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Summary

Background

Segmental non-anatomical colectomy is a current proposed minimally invasive but non-anatomical procedure. However, few studies have compared its efficacy to that of anatomical colectomy.

Objective

To evaluate the prognostic impact of anatomical vs. non-anatomical colectomy in colon cancer.

Patients

Based on the data of 1152 patients who underwent colorectal surgery, the 300 patients with pathologically proven stage II and III colon cancer were included. Patients were divided into two groups, depending on whether the anatomical colectomy (n = 161) or segmental non-anatomical colectomy (n = 139) was performed. The operative procedure was decided by preoperative imaging by taking into account the dominant vessels of the primary tumor. The overall survival and disease-free survival were analyzed.

Results

The number of harvested lymph nodes was significantly larger (p < 0.01) and the metastatic lymph node ratio was significantly lower (p < 0.01) for anatomical colectomy. Mean operation time (p = 0.13), intraoperative blood loss (p = 0.11), and complication (p = 0.70) rates did not differ significantly. The overall survival rates (89.1% vs. 76.9%, p < 0.01) and the 5‑year disease-free survival (86.2% vs. 70.5%, p < 0.01) were significantly better in the anatomical colectomy group than those in the non-anatomical group. The operative procedure (anatomical vs. non-anatomical, odds ratio: 2.65, 95% confidence interval: 1.37–5.35, p < 0.01) was the strongest predictor for overall survival.

Conclusions

Anatomical colectomy has a better prognostic impact than segmental non-anatomical colectomy in stage II and III colon cancer.
Literatur
1.
Zurück zum Zitat Douillard JY, Siena S, Cassidy J, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010;28:4697–705.CrossRefPubMed Douillard JY, Siena S, Cassidy J, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010;28:4697–705.CrossRefPubMed
2.
Zurück zum Zitat de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.CrossRefPubMed de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.CrossRefPubMed
3.
Zurück zum Zitat André T, Boni C, Mounedji-Boudiaf L, et al. Multicenter international study of oxaliplatin/5-fluorouracil/leucovorin in the adjuvant treatment of colon cancer (MOSAIC) investigators. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350:2343–51.CrossRefPubMed André T, Boni C, Mounedji-Boudiaf L, et al. Multicenter international study of oxaliplatin/5-fluorouracil/leucovorin in the adjuvant treatment of colon cancer (MOSAIC) investigators. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350:2343–51.CrossRefPubMed
4.
Zurück zum Zitat Lembersky BC, Wieand HS, Petrelli NJ, et al. Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C‑06. J Clin Oncol. 2006;24:2059–64.CrossRefPubMed Lembersky BC, Wieand HS, Petrelli NJ, et al. Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C‑06. J Clin Oncol. 2006;24:2059–64.CrossRefPubMed
5.
Zurück zum Zitat Park IJ, Choi GS, Kang BM, Lim KH, Jun SH. Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe? Ann Surg Oncol. 2009;16:1501–6.CrossRefPubMed Park IJ, Choi GS, Kang BM, Lim KH, Jun SH. Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe? Ann Surg Oncol. 2009;16:1501–6.CrossRefPubMed
6.
Zurück zum Zitat Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg. 1997;21:109–15.CrossRefPubMed Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg. 1997;21:109–15.CrossRefPubMed
7.
Zurück zum Zitat Morikawa E, Yasutomi M, Shindou K, et al. Distribution of metastatic lymph node in colorectal cancer by the modified clearing method. Dis Colon Rectum. 1994;37:219–23.CrossRefPubMed Morikawa E, Yasutomi M, Shindou K, et al. Distribution of metastatic lymph node in colorectal cancer by the modified clearing method. Dis Colon Rectum. 1994;37:219–23.CrossRefPubMed
8.
Zurück zum Zitat Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. Tokyo: Kanehara; 2010. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma. Tokyo: Kanehara; 2010.
9.
10.
Zurück zum Zitat Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell; 2009. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell; 2009.
11.
Zurück zum Zitat Rouffet F, Hay JM, Vacher B, et al. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum. 1994;37:651–9.CrossRefPubMed Rouffet F, Hay JM, Vacher B, et al. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum. 1994;37:651–9.CrossRefPubMed
12.
Zurück zum Zitat Wang J, Kulaylat M, Rockette H, et al. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg. 2009;249:559–63.CrossRefPubMed Wang J, Kulaylat M, Rockette H, et al. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg. 2009;249:559–63.CrossRefPubMed
13.
Zurück zum Zitat Chen SL, Steele SR, Eberhardt J, Zhu K, Bilchik A, Stojadinovic A. Lymph node ratio as a quality and prognostic indicator in stage III colon cancer. Ann Surg. 2011;253:82–7.CrossRefPubMed Chen SL, Steele SR, Eberhardt J, Zhu K, Bilchik A, Stojadinovic A. Lymph node ratio as a quality and prognostic indicator in stage III colon cancer. Ann Surg. 2011;253:82–7.CrossRefPubMed
14.
Zurück zum Zitat Kim J, Huynh R, Abraham I, Kim E, Kumar RR. Number of lymph nodes examined and its impact on colorectal cancer staging. Am Surg. 2006;72:902–5.PubMed Kim J, Huynh R, Abraham I, Kim E, Kumar RR. Number of lymph nodes examined and its impact on colorectal cancer staging. Am Surg. 2006;72:902–5.PubMed
15.
Zurück zum Zitat Schumacher P, Dineen S, Barnett C Jr, Fleming J, Anthony T. The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg. 2007;194:827–31.CrossRefPubMed Schumacher P, Dineen S, Barnett C Jr, Fleming J, Anthony T. The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg. 2007;194:827–31.CrossRefPubMed
16.
Zurück zum Zitat Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23:8706–12.CrossRefPubMed Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23:8706–12.CrossRefPubMed
17.
Zurück zum Zitat Hashiguchi Y, Hase K, Ueno H, et al. Prognostic significance of the number of lymph nodes examined in colon cancer surgery: clinical application beyond simple measurement. Ann Surg. 2010;251:872–81.CrossRefPubMed Hashiguchi Y, Hase K, Ueno H, et al. Prognostic significance of the number of lymph nodes examined in colon cancer surgery: clinical application beyond simple measurement. Ann Surg. 2010;251:872–81.CrossRefPubMed
Metadaten
Titel
Impact of anatomical versus non-anatomical resection for stage II and III colon cancer
verfasst von
Tomoya Funada, M.D.
Shintaro Yamazaki, M.D.
Mitsugu Kochi, M.D.
Tadatoshi Takayama, M.D
Publikationsdatum
18.04.2018
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2018
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-018-0523-3

Weitere Artikel der Ausgabe 4/2018

European Surgery 4/2018 Zur Ausgabe