EP420 - Laparoscopic D3 Lymph Node Dissection in Right Colon Cancer: Central Lymph Node Metastasis and Survival Outcomes

ePoster Presenter(s)

• 

  Youngjin Kim, MD

  Fellow
  Seoul National University Hospital
  Seoul, Seoul-t'ukpyolsi, Republic of Korea

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

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Author(s)

• 

  Hyun Tae Lim, MD

  Fellow
  Seoul National University Hospital
  Seoul, Seoul-t'ukpyolsi, Republic of Korea

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• JP

  Jae Hyun Park, MD

  Fellow
  Seoul National University Hospital
  Seoul, Seoul-t'ukpyolsi, Republic of Korea

  Disclosure information not submitted.
• 

  Jesung Park, MD, PhD

  Clinical Assistant Professor
  Chung-Ang University Hospital
  Seoul, Seoul-t'ukpyolsi, Republic of Korea

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• SR

  Seung-Bum Ryoo, M.D., Ph.D.

  Professor
  Colorectal Surgery division, Surgery department, Seoul national university hospital
  Seoul, Seoul-t'ukpyolsi, Republic of Korea

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• KP

  Kyu Joo Park, n/a

  Professor
  SNUH
  Seoul, Seoul-t'ukpyolsi, Republic of Korea

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: In recent years, there has been a trend towards adopting D3 dissection, which involves the removal of central lymph nodes, particularly in cases of late-stage disease. This study aims to evaluate the oncologic outcomes of patients undergoing D3 dissection for right colon cancer, with information of metastatic lymph node site.

Methods/Interventions: Single center Retrospective review study. From January 2013 to August 2023, patients who received laparoscopic colon resection with D3 dissection due to right-side colon cancer included. Patients who had other malignancy at same time, colon cancer-related genetic disorder such as HNPCC(hereditary nonpolyposis colorectal cancer), FAP(familial adenomatous polyposis) excluded. Patients were categorized into three groups based on the location of harvested metastatic lymph nodes: the peritumoral group (0-2 cm from the colon), the pericolic group (2-5 cm from the colon), and the central group (beyond 5 cm). Patients with metastasis in more than one location were grouped by the deepest lymph node involved.

Results/Outcomes: Totally 939 patients was reviewed. There were 621 patients without lymph node metastasis(LN(-)) and 318 patients with lymph node metastasis(284 patients in peritumoral site, 91 in pericolic, 12 in central, include duplicated). The characteristics of the two groups were generally similar, but LN(+) group had longer operation time(151 vs 160, minutes), advanced T-stage, larger tumor size(4.2 vs 5, cm), shorter overall survival period(114.4 vs 91.0, month). When dividing LN(+) group by the location of the metastatic lymph nodes (peritumoral/pericolic/central group), the tumor size(4.8 vs 5.2 vs 6.6, cm), and overall survival period(93.6 vs 87.1 vs 32, month) were varied. There were 269 post-operative complications (28.6%), with 21 patients (2.2%) experiencing Clavien-Dindo grade III/IV complications.

Conclusion/Discussion: We could confirm that Patients with lymph nodes metastasis have worse survival rate, and it seems related with large tumor size, advanced T-stage. In the LN(+) group, central group showed worse survival rates compared to peritumoral, pericolic group. Tumor size was shown to be a crucial factor in determining how far the positive lymph nodes have spread.

Clinicopathological Characteristics of Patients with Right Colon Cancer Based on Lymph Node Metastasis
Date are presented as number of patients (percentage) or median value (range)　
*Double primary tumor excluded- 4 cases have two tumors at Right colon. 3 cases' tumors loca-ted at cecum and A-colon and 1 case's tumors located at A-colon and Hepatic flexure.
**9 cases didn't have information about MSI.
BMI: Body Mass Index; HF: Hepatic Flexure; Lapa. RHC: Laparoscopic Right Hemicolectomy, Lapa. ERHC: Laparoscopic Extended Right Hemicolectomy; EBL: Estimated Blood Loss; PRM: Proximal Resection Margin; DRM: Distal Resection Margin; MSS: Microsatellite Stable; MSI: Microsatellite instability.

Kaplan-Meier Survival Curves of Patients Based on Lymph Node Metastasis Location.
The mean overall survival times for each group were as follows: peritumoral (93.5 months), pericolic (87.1 months), and central (30.1 months). Statistically significant differences were observed between the peritumoral and central groups (p < 0.001) and between the pericolic and central groups (p = 0.016).