Optimal margins and lymphadenectomy in colonic cancer surgery
British Journal of Surgery, 05/31/2011
Hashiguchi Y et al. – Current guidelines may encourage needlessly extensive surgery.Methods
- 914 consecutive patients who underwent potentially curative surgery for T2–T4 colonic cancer were reviewed.
- The number of lymph nodes (LNs) examined and the potential contributions to the staging accuracy of the distinct area were analysed.
- The survival benefit of dissection was compared for pericolic (local), mesocolic (intermediate) and main arterial trunk (main) LN.
- Removal of the pericolic LNs within 5 cm of the tumour and intermediate LNs resulted in a mean LN number of 15.9, a sensitivity for overall node positivity of 97.5 %, and a survival benefit calculated as a therapeutic value index of 31.4 points.
- The additional removal of LNs more than 5 cm from the tumour and main LNs did not improve the staging accuracy, while adding only 3.4 points to the survival benefit.