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.
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.
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