Regional and extra-regional lymph node metastasis in right-sided colon cancer: a two-year real-world data analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

REN Haoyuan , LIU Yong , CAO Wen ,  XIANG Rongchao ,  MAI Gang

Department of Gastrointestinal Surgery, Deyang People’s Hospital, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

XIANG Rongchao, Email: 13980134548@163.com; MAI Gang, Email: maigang_dysyy@163.com

Keywords：

right-sided colon cancer; regional lymph node; infrapyloric lymph node; ileocecal-preserving right hemicolectomy; complete mesocolic excision

DOI：

10.7507/1007-9424.202505005

Video：

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Objective This real-world study aimed to clarify the patterns of regional and extra-regional lymph node metastasis to provide evidence for clinical decision-making and future research. Methods A total of 123 patients who underwent laparoscopic right hemicolectomy with complete mesocolic excision (CME) at the Department of Gastrointestinal Surgery, Deyang People’s Hospital from September 2022 to May 2024 were included. Lymph nodes were dissected, classified, and analyzed according to the Japanese Society for Cancer of the Colon and Rectum Guidelines for Colorectal Cancer Treatment (7th edition). Clinicopathological data were analyzed. Results Overall lymph node metastasis rate: 42.3% (52/123). The metastasis rate of para-intestinal lymph nodes (N1) was 33.3% (41/123), intermediate lymph node (N2) was 10.6% (13/123), and central lymph node (N3) was 13.0% (16/123). Cecal cancer: ileocolic artery lymph node metastasis rate was 40.0% (10/25), right colic artery lymph node metastasis rate was 0 (0/6) and middle colic artery lymph node metastasis rate was 4.0% (1/25). Transverse colon cancer: ileocolic artery lymph node metastasis rate was 0 (0/18) and middle colic artery lymph node metastasis rate was 33.3% (6/18). Of 45 patients with infrapyloric lymph node dissection, only 1 (2.2%) patient with hepatic flexure cancer showed metastasis. The metastasis rate was 2.2% (1/45). No ileal lymph node metastasis was observed. N3 metastasis rate: 9.3% (8/86) in well/moderately differentiated tumors vs 21.6% (8/37) in poorly differentiated tumors (χ²=2.63, P=0.105). No N3 lymph node metastasis occurred in T1 and T2 tumors. T3 and T4 tumors exhibited N3 metastasis rates of 13.3% (13/98) and 21.4% (3/14), respectively (χ²=0.17, P=0.683). Conclusions For cancer of the ileocecal region, lymph node metastasis beside the colic middle artery almost never occurs. And for transverse colon cancer, no lymph node metastasis beside the ileocolic artery has been found. suggesting that when the tumor is located in these areas, excessive resection of the intestine is not necessary, and a right hemicolectomy with ileocecal preservation can be performed to better preserve organ function. For poorly differentiated cancers and right-sided colon cancers on T3 and T4 stages, the N3 lymph node metastasis rates are high (more than 20%), respectively, and D3 lymph node dissection is still recommended. The rate of extra-regional lymph node metastasis is extremely low, and routine dissection is not recommended.

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2.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3.	Sahara K, Watanabe J, Ishibe A, et al. Optimal extent of central lymphadenectomy for right-sided colon cancers: is lymphadenectomy beyond the superior mesenteric vein meaningful?. Surg Today, 2021, 51(2): 268-275.
4.	Sun Y, Zhang D, Feng Y, et al. Infrapyloric lymph node dissection in right hemicolectomy for colon cancer: should prophylactic resection be recommended?. J Surg Oncol, 2021, 123 Suppl 1: S30-S35. doi: 10.1002/jso.26388.
5.	Lu J, Xing J, Zang L, et al. Extent of lymphadenectomy for surgical management of right-sided colon cancer: the randomized phase Ⅲ RELARC trial. J Clin Oncol, 2024, 42(33): 3957-3966.
6.	Xu L, Su X, He Z, et al. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol, 2021, 22(3): 391-401.
7.	Su H, Wu H, Mu B, et al. The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer. World J Surg Oncol, 2020, 18(1): 159. doi: 10.1186/s12957-020-01922-8.
8.	Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol, 2020, 25(1): 1-42.
9.	Liu J, Su Y, Liu X, et al. Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No. 206) and terminal ileum lymph nodes in patients with right colon cancer. World J Surg Oncol, 2021, 19(1): 310. doi: 10.1186/s12957-021-02414-z.
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11.	West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol, 2012, 30(15): 1763-1769.
12.	Kataoka K, Ysebaert H, Shiozawa M, et al. Prognostic significance of number versus location of positive mesenteric nodes in stage Ⅲ colon cancer. Eur J Surg Oncol, 2019, 45(10): 1862-1869.
13.	Sammour T, Malakorn S, Thampy R, et al. Selective central vascular ligation (D3 lymphadenectomy) in patients undergoing minimally invasive complete mesocolic excision for colon cancer: optimizing the risk-benefit equation. Colorectal Dis, 2020, 22(1): 53-61.
14.	Park IJ, Choi GS, Kang BM, et al. Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe?. Ann Surg Oncol, 2009, 16(6): 1501-1506.
15.	向波, 韦福康, 罗启成, 等. 回盲部和右半结肠切除后早期对机体影响的实验研究. 中国普外基础与临床杂志, 2002, 9(2): 96-99.
16.	Lan YT, Lin JK, Jiang JK, et al. Significance of lymph node retrieval from the terminal ileum for patients with cecal and ascending colonic cancers. Ann Surg Oncol, 2011, 18(1): 146-152.
17.	于亮, 段绍斌, 刘郁, 等. 经腹腔镜结肠肝曲癌的幽门下淋巴结清扫. 中国普外基础与临床杂志, 2017, 24(8): 1000-1002.
18.	Feng B, Ling TL, Lu AG, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc, 2014, 28(2): 477-483.
19.	Uematsu D, Akiyama G, Sugihara T, et al. Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure. Asian J Endosc Surg, 2017, 10(1): 23-27.
20.	Yalikun A, Cai Z, Hong HJ, et al. Infrapyloric (No. 206) and greater curvature (No. 204) lymph node metastasis in adenocarcinoma located in the right half of the transverse colon (InCLART Study): protocol for a multicentre prospective observational study. BMJ Open, 2023, 13(2): e066981. doi: 10.1136/bmjopen-2022-066981.

1. 李琳, 李旭, 谭坤, 等. 中美结直肠癌流行病学现状及趋势. 中国普外基础与临床杂志, 2025, 32(6): 694-701.
2. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3. Sahara K, Watanabe J, Ishibe A, et al. Optimal extent of central lymphadenectomy for right-sided colon cancers: is lymphadenectomy beyond the superior mesenteric vein meaningful?. Surg Today, 2021, 51(2): 268-275.
4. Sun Y, Zhang D, Feng Y, et al. Infrapyloric lymph node dissection in right hemicolectomy for colon cancer: should prophylactic resection be recommended?. J Surg Oncol, 2021, 123 Suppl 1: S30-S35. doi: 10.1002/jso.26388.
5. Lu J, Xing J, Zang L, et al. Extent of lymphadenectomy for surgical management of right-sided colon cancer: the randomized phase Ⅲ RELARC trial. J Clin Oncol, 2024, 42(33): 3957-3966.
6. Xu L, Su X, He Z, et al. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol, 2021, 22(3): 391-401.
7. Su H, Wu H, Mu B, et al. The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer. World J Surg Oncol, 2020, 18(1): 159. doi: 10.1186/s12957-020-01922-8.
8. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol, 2020, 25(1): 1-42.
9. Liu J, Su Y, Liu X, et al. Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No. 206) and terminal ileum lymph nodes in patients with right colon cancer. World J Surg Oncol, 2021, 19(1): 310. doi: 10.1186/s12957-021-02414-z.
10. Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition [Secondary Publication]. J Anus Rectum Colon, 2019, 3(4): 175-195.
11. West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol, 2012, 30(15): 1763-1769.
12. Kataoka K, Ysebaert H, Shiozawa M, et al. Prognostic significance of number versus location of positive mesenteric nodes in stage Ⅲ colon cancer. Eur J Surg Oncol, 2019, 45(10): 1862-1869.
13. Sammour T, Malakorn S, Thampy R, et al. Selective central vascular ligation (D3 lymphadenectomy) in patients undergoing minimally invasive complete mesocolic excision for colon cancer: optimizing the risk-benefit equation. Colorectal Dis, 2020, 22(1): 53-61.
14. Park IJ, Choi GS, Kang BM, et al. Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe?. Ann Surg Oncol, 2009, 16(6): 1501-1506.
15. 向波, 韦福康, 罗启成, 等. 回盲部和右半结肠切除后早期对机体影响的实验研究. 中国普外基础与临床杂志, 2002, 9(2): 96-99.
16. Lan YT, Lin JK, Jiang JK, et al. Significance of lymph node retrieval from the terminal ileum for patients with cecal and ascending colonic cancers. Ann Surg Oncol, 2011, 18(1): 146-152.
17. 于亮, 段绍斌, 刘郁, 等. 经腹腔镜结肠肝曲癌的幽门下淋巴结清扫. 中国普外基础与临床杂志, 2017, 24(8): 1000-1002.
18. Feng B, Ling TL, Lu AG, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc, 2014, 28(2): 477-483.
19. Uematsu D, Akiyama G, Sugihara T, et al. Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure. Asian J Endosc Surg, 2017, 10(1): 23-27.
20. Yalikun A, Cai Z, Hong HJ, et al. Infrapyloric (No. 206) and greater curvature (No. 204) lymph node metastasis in adenocarcinoma located in the right half of the transverse colon (InCLART Study): protocol for a multicentre prospective observational study. BMJ Open, 2023, 13(2): e066981. doi: 10.1136/bmjopen-2022-066981.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesRegional and extra-regional lymph node metastasis in right-sided colon cancer: a two-year real-world data analysis

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