The pattern of lymphatic spread of left colon cancer: the study of specimen after segmental resection with vessel-sparing complete lymph node dissection

Introduction. The extent of lymphatic spread of cancer in colon lesions determines the treatment options and prognosis for the patient.

The purpose of the study. To study the pattern of lymph node metastasis in left colon cancer.

Materials and methods. 53 pathomorphological studies of the surgical material after preliminary detailed preparation by the surgeon were analyzed from March 2022 till December 2023.

Treatment results. After segmental colonic resection with D3 lymph node dissection and selective vascular ligation, a median number of 62 (IQR: 38-20) regional lymph nodes were excised. A median of 11 (IQR: 6-2) apical lymph nodes were removed. The median number of metastatic paracolic nodes was 9 lymph nodes (IQR: 4-0). There were 4 metastatic intermediate lymph nodes in median (min-max: 0–8), and 1 metastatic lymph node in the apical group. The metastatic spread in apical lymph nodes occurred in 3 of 53 patients (5,7 %,). Apical lymph node metastasis occurred only in sigmoid colon cancer in 7,1 % of cases.

Conclusion. Metastatic apical lymph node spread is found in sigmoid colon cancer. Complete lymph node dissection with tumor-specific mesocolic excision allows to perform more accurate staging and radical surgery in patients with left colon cancer.

1. Hohenberger W., Weber K., Matzel K., Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: Complete mesocolic excision and central ligation - Technical notes and outcome. Color Dis., 2009, May 1; № 11(4), рр. 354–64. doi: 10.1111/j.1463-1318.2008.01735.x

2. Kataoka K., Beppu N., Shiozawa M., Ikeda M., Tomita N., Kobayashi H., et al. Colorectal cancer treated by resection and extended lymphadenectomy: patterns of spread in left- and right-sided tumours. Br J Surg. 2020;107(8):1070–8.

3. Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition. J Anus, Rectum Colon., 2019, Oct 30; № 3(4), рр. 175–95.

4. West N. P., Kobayashi H., Takahashi K., Perrakis A., Weber K., Hohenberger W. et al. Understanding optimal colonic cancer surgery: Comparison of Japanese D3 resection and european complete mesocolic excision with central vascular ligation. J Clin Oncol., 2012, № 30(15), рр. 1763–1769.

5. Kobayashi M., Okamoto K., Namikawa T., Okabayashi T., Sakamoto J., Hanazaki K. Laparoscopic D3 lymph node dissection with preservation of the superior rectal artery for the treatment of proximal sigmoid and descending colon cancer. J Laparoendosc Adv Surg Tech., 2007, № 17(4), рр. 461–466.

6. Efetov S., Zubayraeva A., Kayaalp C., Minenkova A., Bağ Y., Alekberzade A., Tsarkov P.V. Selective approach to arterial ligation in radical sigmoid colon cancer surgery with D3 lymph node dissection: A multicenter comparative study. Turkish J Surg., 2022, № 38(4), рр. 382–390.

7. Efetov S.K., Zubayraeva A.A., Kayaalp C. Complete Lymph Node Dissection as a Vascular- Sparing Alternative to Complete Mesocolic Excision for Colon Cancer. Turkish J Color Dis., 2023, Jun 20; № 33(2), рр. 55–57. https://doi.org/10.4274/tjcd.galenos.2023.2023-1-3

8. Field K., Platell C., Rieger N., Skinner I., Wattchow D., Jones I. et al. Lymph node yield following colorectal cancer surgery. ANZ J Surg., 2011, № 81(4), рр. 266–271.

9. Hsu T. W., Lu H. J., Wei C. K., Yin W. Y., Chang C. M., Chiou W. Y. et al. Clinical and Pathologic Factors Affecting Lymph Node Yields in Colorectal Cancer. PLoS One., 2013, № 8(7), рр. 68526. Available from: www.plosone.org

10. Watanabe J., Ota M., Suwa Y., Ishibe A., Masui H., Nagahori K. Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging. Int J Colorectal Dis., 2017, Feb; № 32(2), рр. 201–207. https://doi.org/10.1007/s00384-016-2669-4

11. Yamaoka Y., Shiomi A., Kagawa H., Hino H., Manabe S., Kato S., Hanaoka M. Which is more important in the management of splenic flexure colon cancer: strict central lymph node dissection or adequate bowel resection margin? Tech Coloproctol., 2020, Aug; № 24(8), рр. 873–882. https://doi.org/10.1007/s10151-020-02260-3

12. Lee S. Y., Yeom S. S., Kim C. H., Kim Y. J., Kim H. R. Distribution of lymph node metastasis and the extent of lymph node dissection in descending colon cancer patients. ANZ J Surg., 2019, Sep; № 89(9), рр. E373-E378. https://doi.org/10.1111/ans.15400

13. Yi J. W., Lee T. G., Lee H. S., Heo S. C., Jeong S. Y., Park K. J., Kang S. B. Apical-node metastasis in sigmoid colon or rectal cancer: is it a factor that indicates a poor prognosis after high ligation? Int J Colorectal Dis., 2012, Jan; № 27(1), рр. 81–87. https://doi.org/10.1007/s00384-011-1271-z

14. Karachun A., Panaiotti L., Chernikovskiy I., Achkasov S., Gevorkyan Y., Savanovich N., Sharygin G., Markushin L., Sushkov O., Aleshin D., Shakhmatov D., Nazarov I., Muratov I., Maynovskaya O., Olkina A., Lankov T., Ovchinnikova T., Kharagezov D., Kaymakchi D., Milakin A., Petrov A. Short-term outcomes of a multicentre randomized clinical trial comparing D2 versus D3 lymph node dissection for colonic cancer (COLD trial). Br J Surg., 2020, Apr; № 107(5), рр. 499–508. https://doi.org/10.1002/bjs.11387

15. Samofalova O. Yu., Tulina I. A., Kravchenko A. Yu., Bashankaev B. N., Fedorov D. N., Paltseva E. M., Tsarkov P. V. Analysis of lymphogenous metastasis of colon cancer I–III stage according to the results of D3 lymph node dissection. Creative surgery and oncology, 2012, № 2, рр. 57–68.