Optimal Extent of Lymph Node Dissection for Non-Metastatic Colon Cancer by Tumor Location: Evaluation of the Therapeutic Value Index for Each Lymph Node Station

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2025-04-21 DOI:10.1002/ags3.70023

Akira Ouchi, Kozo Kataoka, Eiji Shinto, Takashi Akiyoshi, Takefumi Yoshida, Yasuyuki Takamizawa, Yukihide Kanemitsu, Hirotoshi Kobayashi, Yoichi Ajioka, the Lymph Nodes Committee of JSCCR

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Abstract

Aims

To determine the optimal extent of lymph node dissection for non-metastatic colon cancer by tumor location based on the therapeutic value index (TVI) for each lymph node station.

Methods

Consecutive patients with surgical stage I–III colon or rectosigmoid cancer in the Japanese Society for Cancer of the Colon and Rectum database who underwent curative resection between January 2003 and December 2014 were analyzed. The TVI was defined as the incidence of lymph node metastasis multiplied by 5-year overall survival and calculated for each nodal station stratified by tumor location.

Results

A total of 33 231 patients were eligible for analysis. In cecal cancer, the TVI was 2.086 for nodal station #203, but only 0.000 for #213. In ascending colon cancer, the TVI was 1.080 for #203 and 0.644 for #213, but only 0.178 for #223. In transverse colon cancer, the TVI was 1.942 for #223, but only 0.066 for #213 and 0.159 for #203. In descending colon cancer, the TVI was 0.215 for #253. The TVI was 1.172 for #253 in sigmoid colon cancer and 1.155 for #253 in rectosigmoid cancer.

Conclusion

Considering that a previous systematic review reported TVIs in the range of 0.295–0.576 for the para-aortic lymph nodes in patients with colorectal cancer, dissection of the main lymph nodes along the feeding artery has a therapeutic value in non-metastatic colon cancers. Meanwhile, the significance of #253 dissection for descending colon cancer requires further discussion.

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非转移性结肠癌肿瘤部位淋巴结清扫的最佳范围：各淋巴结站治疗价值指数的评价

目的根据各淋巴结站的治疗价值指数（therapeutic value index， TVI）确定肿瘤部位非转移性结肠癌的最佳淋巴结清扫程度。方法对2003年1月至2014年12月日本结直肠癌症协会数据库中连续行根治性手术切除的I-III期结肠癌或直肠乙状结肠癌患者进行分析。TVI定义为淋巴结转移发生率乘以5年总生存率，并按肿瘤位置分层计算每个淋巴结站。结果共有33 231例患者符合分析条件。盲肠癌203节点站TVI为2.086,213节点站TVI仅为0.000。在升结肠癌中，203号的TVI为1.080,213号为0.644，而223号仅为0.178。在横断面结肠癌中，223号的TVI为1.942，而213号和203号的TVI仅为0.066和0.159。在降结肠癌中，253号患者的TVI为0.215。#253乙状结肠的TVI为1.172，#253直肠乙状结肠的TVI为1.155。结论考虑到已有系统综述报道结直肠癌主动脉旁淋巴结TVIs在0.295 ~ 0.576之间，沿供血动脉清扫主淋巴结对非转移性结肠癌具有治疗价值。同时，253号夹层对降结肠癌的意义有待进一步探讨。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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