ESMO Gastrointestinal Oncology (Sep 2025)
Lymph node mapping-based optimal bowel-resection margin and central radicality in colon cancer surgery: an international, prospective, observational cohort study
- H. Ueno,
- N.K. Kim,
- J.C. Kim,
- P. Tsarkov,
- W. Hohenberger,
- R. Grützmann,
- N.E Samalavičius,
- A. Dulskas,
- J.-T. Liang,
- P. Quirke,
- N. West,
- A. Shiomi,
- M. Ito,
- M. Shiozawa,
- K. Komori,
- K. Matsuda,
- Y. Kinugasa,
- T. Sato,
- K. Yamada,
- Y. Hashiguchi,
- H. Ozawa,
- Y. Kanemitsu,
- T. Kusumi,
- H. Ike,
- Y. Takii,
- H. Matsuoka,
- Y. Toiyama,
- J. Watanabe,
- A. Ishibe,
- H. Sonoda,
- K. Koda,
- F. Fujita,
- M. Ohue,
- M. Itabashi,
- M. Taketsuna,
- S. Higashide,
- Y. Ajioka,
- K. Sugihara
Affiliations
- H. Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan; Correspondence to: Prof Hideki Ueno, MD, PhD, Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. Tel: +81-42-995-1637; Fax: +81-42-996-5205
- N.K. Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- J.C. Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- P. Tsarkov
- Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
- W. Hohenberger
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
- R. Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
- N.E Samalavičius
- Center of General Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania; Clinic of Internal Diseases and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- A. Dulskas
- Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
- J.-T. Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- P. Quirke
- Pathology and Data Analytics, Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK
- N. West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK
- A. Shiomi
- Division of Colorectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
- M. Ito
- Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan
- M. Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
- K. Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
- K. Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
- Y. Kinugasa
- Department of Gastrointestinal Surgery, Institute of Science Tokyo, Tokyo, Japan
- T. Sato
- Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
- K. Yamada
- Department of Gastroenterological Surgery, Coloproctology Center, Takano Hospital, Kumamoto, Japan
- Y. Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
- H. Ozawa
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
- Y. Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
- T. Kusumi
- Department of Surgery, Keiyukai Sappro Hospital, Hokkaido, Japan
- H. Ike
- Department of Surgery, Saisei-kai Yokohama-shi Nanbu Hospital, Kanagawa, Japan
- Y. Takii
- Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
- H. Matsuoka
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
- Y. Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
- J. Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan
- A. Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
- H. Sonoda
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
- K. Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
- F. Fujita
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
- M. Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
- M. Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
- M. Taketsuna
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation, Hyogo, Japan
- S. Higashide
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation, Hyogo, Japan
- Y. Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
- K. Sugihara
- Institute of Science Tokyo, Tokyo, Japan
- DOI
- https://doi.org/10.1016/j.esmogo.2025.100231
- Journal volume & issue
-
Vol. 9
p. 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.
Keywords
- colon cancer
- bowel-resection margin
- central radicality
- D3 lymph node dissection
- complete mesocolic excision
- lymph node mapping
