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Clinical impact of D3 lymph node dissection with left colic artery (LCA) preservation compared to D3 without LCA preservation: Exploratory subgroup analysis of data from JCOG0404

Authors :
Masaaki Ito
Kenichi Sugihara
Masafumi Inomata
Tsunekazu Hanai
Yoshihisa Saida
Tomonori Akagi
Shigeki Yamaguchi
Seiichiro Yamamoto
Takao Hara
Yusuke Kinugasa
Masahiko Watanabe
Seigo Kitano
Dai Shida
Masayuki Ohue
Junki Mizusawa
Yukihide Kanemitsu
Tadahiko Masaki
Haruhiko Fukuda
Hiroshi Katayama
Source :
Annals of Gastroenterological Surgery, Annals of Gastroenterological Surgery, Vol 4, Iss 2, Pp 163-169 (2020)
Publication Year :
2020
Publisher :
Wiley, 2020.

Abstract

Aim We investigated the clinical impact of D3 lymph node dissection preserving left colic artery (LCA) compared to D3 without LCA preservation using data from JCOG0404. LCA preservation is expected to maintain adequate blood supply, which is effective in preventing anastomotic leakage, intestinal paralysis, and bowel obstruction. Whether D3 with LCA preservation (Group A) improves clinical outcomes following resection of sigmoid colon cancer compared to D3 without LCA preservation (Group B) is unclear. Methods Procedure type was identified from photographs of the surgical field collected for central surgical review in JCOG0404. Clinical outcomes were compared between each procedure. Results Among the 1057 randomized patients in JCOG0404, 631 patients receiving sigmoid colectomy or anterior resection were included in the subgroup analysis. Group A comprised of 135 patients and Group B of 496 patients. Patient backgrounds did not differ between groups. Median operative time, blood loss, anastomotic leakage, and intestinal paralysis were not remarkably different (Group A vs Group B: 185 vs 186 minutes, 60 vs 50 mL, 3.0% vs 5.0%, and 2.2% vs 3.8%). More overall postoperative complications occurred in Group B than Group A (21.6% vs 9.6%, P = .022). Five‐year relapse‐free survival (RFS) and overall survival (OS) tended to be better in Group A than Group B (RFS: 83.7% and 80.5%, HR 0.80 [95% CI 0.51‐1.26], OS: 96.3% and 91.1%, HR 0.41 [95% CI 0.19‐0.89]). Conclusions Short‐ and long‐term outcomes tend to be better in Group A than Group B, indicating that preservation of LCA could be an alternative treatment.<br />Our analysis for stage II/III sigmoid and rectosigmoid colon cancer found that short‐ and long‐term outcomes were better in D3 dissection with preservation of the LCA than D3 dissection without preservation of the LCA. We concluded that D3 lymph node dissection with preservation of the LCA could be an alternative treatment for D3 lymph node dissection.

Details

ISSN :
24750328
Volume :
4
Database :
OpenAIRE
Journal :
Annals of Gastroenterological Surgery
Accession number :
edsair.doi.dedup.....19d72f87d93f4879b816b492c76a3e4b
Full Text :
https://doi.org/10.1002/ags3.12318