Lymph node mapping-based optimal bowel-resection margin and central radicality in colon cancer surgery: an international, prospective, observational cohort study

Ueno H, Kim NK, Kim JC, Tsarkov P, Hohenberger W, Grützmann R, Samalavičius NE, Dulskas A, Liang JT, Quirke P, West N, Shiomi A, Ito M, Shiozawa M, Komori K, Matsuda K, Kinugasa Y, Sato T, Yamada K, Hashiguchi Y, Ozawa H, Kanemitsu Y, Kusumi T, Ike H, Takii Y, Matsuoka H, Toiyama Y, Watanabe J, Ishibe A, Sonoda H, Koda K, Fujita F, Ohue M, Itabashi M, Taketsuna M, Higashide S, Ajioka Y, Sugihara K (2025)

Publication Type: Journal article

Publication year: 2025

Book Volume: 9

Article Number: 100231

DOI: 10.1016/j.esmogo.2025.100231

Abstract

Background: Substantial variations in the extent of lymphadenectomy are acknowledged internationally in colon cancer surgery because essential data for standardization, including the anatomical distribution of metastatic lymph nodes (LN), are lacking. Materials and methods: Pre-specified LN mappings based on in vivo bowel measurements were conducted for stages I-III colon cancer patients treated at 31 leading hospitals in six countries. The extent of lymphadenectomy was classified from levels A (pericolic) to C (central LNs) according to the pre-specified anatomical landmarks. The primary outcome was the extent of pericolic lymphatic spread and the incidence of metastasis in central LNs, and secondary ones included the real-world status of central radicality and its association with short-term outcomes. Results: Among 3647 patients, pericolic spread beyond 10 cm (0.2%) and absence of feeding arteries supplying the bowel within 10 cm from the primary tumor (0.3%) were rare, irrespective of nationality. The incidence of metastasis in central LNs was ∼3% (range: 0.2% in T1 to 7% in T4 tumors) and was lower in tumors located at the splenic flexure (0.5%). The proportion of patients with level C radicality was ∼76%, which was statistically significantly associated with T stage only in one country. A higher radicality level conferred no adverse impact on either the incidence of Clavien–Dindo grade ≥III or 30-day mortality. Conclusions: The ‘10-cm rule’ could be an international criterion for determining the bowel-resection margin. Central lymphadenectomy is feasible internationally, though the indication should be selective, not routine, depending on the stage and location of the primary tumor.

Authors with CRIS profile

Involved external institutions

Institute of Science Tokyo (ISCT) / 東京科学大学 Japan (JP) Yamagata Prefectural Central Hospital / 山形県立中央病院 Japan (JP) Takano Hospital / 高野病院 Japan (JP) National Cancer Center Hospital Japan (JP) Keiyukai Sapporo Hospital / 社会医療法人恵佑会札幌病院 Japan (JP) Saiseikai Yokohamashi Nanbu Hospital / 済生会横浜市南部病院 Japan (JP) Niigata University of Pharmacy and Applied Life Sciences / 新潟薬科大学 Japan (JP) Kyorin University / 杏林大学 Japan (JP) Mie University / 三重大学 Japan (JP) Yokohama City University Hospital / 横浜市立大学附属病院 Japan (JP) Shiga University of Medical Science Japan (JP) Teikyo University Chiba Medical Center / 帝京大学ちば総合医療センター Japan (JP) Osaka International Cancer Institute / 大阪国際がん研究所 Japan (JP) National Defense Medical College / 防衛医科大学校 Japan (JP) Tokyo Women's Medical University Japan (JP) Teikyo University Japan (JP) Tochigi Cancer Center / 栃木県立がんセンター Japan (JP) Niigata University / 新潟大学 Japan (JP) Yonsei University Health System (YUHS) Korea, Republic of (KR) University of Ulsan / 울산대학교 Korea, Republic of (KR) I.M. Sechenov First Moscow State Medical University Russian Federation (RU) Vilnius University / Vilniaus universitetas Lithuania (LT) National Cancer Institute (NCI) United States (USA) (US) National Taiwan University Hospital (NTUH) / 國立台灣大學醫學院附設醫院 Taiwan (TW) University of Leeds United Kingdom (GB) Shizuoka Cancer Center (SCC) / 静岡県立 静岡がんセンター Japan (JP) National Cancer Center Hospital East / 国立がん研究センター東病院 Japan (JP) Kanagawa Prefectural Hospital / Kanagawa Cancer Center / 神奈川県立がんセンター Japan (JP) Aichi Cancer Center Research Institute Japan (JP) Wakayama Medical University Japan (JP)

How to cite

APA:

Ueno, H., Kim, N.K., Kim, J.C., Tsarkov, P., Hohenberger, W., Grützmann, R.,... Sugihara, K. (2025). Lymph node mapping-based optimal bowel-resection margin and central radicality in colon cancer surgery: an international, prospective, observational cohort study. , 9. https://doi.org/10.1016/j.esmogo.2025.100231

MLA:

Ueno, H., et al. "Lymph node mapping-based optimal bowel-resection margin and central radicality in colon cancer surgery: an international, prospective, observational cohort study." 9 (2025).

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