Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery : The influence of the site of the primary feeding artery

• Published in: Diseases of the colon & rectum Vol. 48; no. 12; pp. 2232 - 2237
• Main Authors: HIDA, Jin-Ichi, OKUNO, Kiyotaka, YASUTOMI, Masayuki, YOSHIFUJI, Takehito, UCHIDA, Toshihiro, TOKORO, Tadao, SHIOZAKI, Hitoshi
• Format: Journal Article
• Language: English
• Published: Secaucus, NJ Springer 01.12.2005; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Arteries - surgery; Biological and medical sciences; Colectomy - methods; Colonic Neoplasms - blood supply; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Ligation; Lymph Node Excision; Lymphatic Metastasis; Medical sciences; Neoplasm Invasiveness; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Tumors; Lymph node; Lymph node dissection; Primary feeding artery; Clearing method; Surgical resection; Colectomy; Malignant tumor; Colonic disease; Nutrient artery; Colon cancer; Treatment; Surgery; Gastroenterology; Digestive diseases; Intestinal disease; Bowel resection margin
• DOI: 10.1007/s10350-005-0161-2
• ISSN: 0012-3706

In colon cancer surgery, it is recommended that en bloc resection involving extended lymphadenectomy, characterized as a hemicolectomy, be performed by ligating the primary feeding artery at a high position and resecting proximal and distal with 5-cm to 10-cm bowel margins. However, there is little evidence to unequivocally support such extensive lymphovascular resection. The distribution of nodal metastases was obtained by the clearing method in 164 patients with colon cancer. For pericolic spread, for pT1 tumors, the distance from the primary tumor to a diseased node was 2.5 cm; for pT2, the distance was less than 5 cm; for 97.0 percent of pT3 tumors and 93.3 percent of pT4 tumors with nodes involved, the distance was less than 7 cm. For central spread, for pT1 tumors, the rate of spread to central nodes was 0 percent; for pT2, the rate of spread was 20.0 percent to intermediate nodes (for tumors more than 5 cm from the feeding artery, the rate for central nodes was 0 percent); for pT3, the rate was 30.6 percent to intermediate nodes and 15.3 percent to main nodes; for pT4, the rate was 44.4 percent to intermediate nodes and 22.2 percent to main nodes. For curative resection cases with pT3 tumors more than 7 cm from the feeding artery, the rate to central nodes was 0 percent. In T1 tumors, central node dissection is not required, but resection with proximal and distal 3-cm margins are required; in T2, central node dissection that includes the intermediate node should be performed in addition to resection with proximal and distal 5-cm margins. In T3 and T4, central node dissection that includes the main node should be performed in addition to resection with proximal and distal 7-cm margins. However, for T2 more than 5 cm from the primary feeding artery, and for T3 more than 7 cm from the primary feeding artery, proximal and distal resection alone may be adequate.