Prognostic value of lymph node distribution after laparoscopic colectomy with Japanese D3 dissection

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Positive lymph nodes are critical prognostic indicators in colorectal cancer.
• The relative importance of lymph node distribution versus metastatic node count for survival prediction is debated.

Purpose of the Study:

• To compare the prognostic impact of central vessel metastasis (LND3) versus other lymph node dissections (LND1/2) in pathological stage III colorectal cancer.
• To evaluate survival differences and the effect of adjuvant chemotherapy based on lymph node metastasis patterns.

Main Methods:

• Retrospective analysis of 604 stage III colorectal cancer patients undergoing laparoscopic resection.
• Patients were categorized into LND3 (central vessel metastasis) and LND1/2 groups.
• Propensity score matching was used to control for background factors and compare prognosis.

Main Results:

• The LND3 group exhibited significantly worse 5-year recurrence-free survival (RFS) and overall survival (OS) compared to the LND1/2 group.
• Adjuvant chemotherapy demonstrated a significant improvement in RFS for patients in the LND3 group.
• Pre-matching analysis showed higher frequencies of right-side colon cancer and multivisceral resection in the LND3 group.

Conclusions:

• Central vessel metastasis (LND3) is associated with a poorer prognosis in stage III colorectal cancer.
• Patients with LND3-positive status require specific perioperative treatment strategies.
• Further research into tailored treatment approaches for LND3-positive colorectal cancer is warranted.