Interactions of occult tumor spread and surgical technique on overall and disease-free survival in patients operated for stage I and II right-sided colon cancer

• Published in: Journal of cancer research and clinical oncology Vol. 147; no. 12; pp. 3535 - 3543
• Main Authors: Banipal, G. S., Stimec, B. V., Andersen, S. N., Faerden, A. E., Edwin, B., Baral, J., Benth, J. Šaltytė, Ignjatovic, D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2021; Springer Nature B.V
• Subjects: Aged; Angiography; Cancer Research; Colectomy - adverse effects; Colectomy - methods; Colon cancer; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal cancer; Computed tomography; Disease-Free Survival; Female; Hematology; Humans; Internal Medicine; Laparotomy - adverse effects; Laparotomy - methods; Lymph nodes; Lymphatic Metastasis - pathology; Lymphatic system; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Monoclonal antibodies; NCT; NCT01351714; Oncology; Original Article – Cancer Research; Original – Cancer Research; Patients; Surgical techniques; Tumor cells; Tumors; Micro metastases; Isolated tumor cells; Stage I/II right-side colon cancer; Occult tumor spread; D3 right colectomy
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-021-03773-6

Purpose
To determine if “medial to lateral” (ML) dissection with devascularization first is superior to “lateral to medial” (LM) dissection regarding numbers of lymph node micro metastases (MM) and isolated tumor cells (ITC) as well as 5-year disease-free (5YDFS) and 5-year overall survival (5YOS) in stage I/II right-sided colon cancer.
Methods
Two datasets are used. ML group consists of consecutive stage I/II patients from a prospective trial. LM group is the original dataset from a previous publication. All harvested lymph nodes are examined with monoclonal antibody CAM 5.2 (immunohistochemically). Lymph node harvest and 5YOS/5YDFS were compared between ML/LM groups, stage I/II tumors and MM/ITC presence/absence.
Results
117 patients included ML:51, LM:66. MM/ITC positive in ML 37.3% (19/51), LM 31.8% (21/66)
p
 = 0.54. The 5YDFS for patients in ML 70.6% and LM 69.7%,
p
 = 0.99, 5YOS: 74.5% ML and 71.2% LM (
p
 = 0.73). No difference in 5YDFS/5YOS between groups for Stage I/II tumors; however, LM group had an excess of early tumors (16) when compared to ML group, while lymph node harvest was significantly higher in ML group (
p
 < 0.01) 15.1 vs 26.7. 5YDFS and 5YOS stratified by MM/ITC presence/absence was 67.5%/71.4%,
p
 = 0.63, and 75.0%/71.4%,
p
 = 0.72, respectively. Death due to recurrence in MM/ITC positive was significantly higher than MM/ITC negative (
p
 = 0.012).
Conclusion
Surgical technique does not influence numbers of MM/ITC or 5YDFS/5YOS. Presence of MM/ITC does not affect 5YOS/5YDFS but can be a potential prognostic factor for death due to recurrence.
Clinical trial
Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-Detector Computed Tomography (MDCT) Angiography” registered at
http://clinicaltrials.gov/ct2/show/NCT01351714
.