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Are Metastatic Central Lymph Nodes (D3 volume) in right-sided Colon Cancer a Sign of Systemic Disease? A sub-group Analysis of an Ongoing Multicenter Trial. | LitMetric

AI Article Synopsis

  • The study evaluates the outcomes of patients with right-sided colon cancer who have central lymph node metastases (D3-PNG) after undergoing personalized surgical treatment, emphasizing the importance of targeted dissection.
  • Results show that patients categorized as having residual disease negative (D3-RDN) have significantly better overall survival and disease-free survival rates compared to those with residual disease positive (D3-RDP), highlighting the effectiveness of surgical intervention.
  • The findings suggest that the quality and extent of the surgery, along with experience gained over time, can lead to improved patient outcomes, indicating a need for centralized treatment approaches for these complex cases.

Article Abstract

Objective: Assess outcomes of patients with right-sided colon cancer with metastases in the D3 volume after personalized surgery.

Background: Patients with central lymph node metastasis (D3-PNG) are considered to have a systemic disease with a poor prognosis. A 3-dimensional definition of the dissection volume allows the removal of all central nodes.

Materials And Methods: D3-PNG includes consecutive patients from an ongoing clinical trial. Patients were stratified into residual disease negative (D3-RDN) and residual disease positive (D3-RDP) groups. D3-RDN was further stratified into 4 periods to identify a learning curve. A personalized D3 volume (defined through arterial origins and venous confluences) was removed " en bloc" through medial-to-lateral dissection, and the D3 volume of the specimen was analyzed separately.

Results: D3-PNG contained 42 (26 females, 63.1 SD 9.9 y) patients, D3-RDN:29 (17 females, 63.4 SD 10.1 y), and D3-RDP:13 (9 females, 62.2 SD 9.7 y). The mean overall survival (OS) days were D3-PNG:1230, D3-RDN:1610, and D3-RDP:460. The mean disease-free survival (DFS) was D3-PNG:1023, D3-RDN:1461, and D3-RDP:74 days. The probability of OS/DFS were D3-PNG:52.1%/50.2%, D3-RDN:72.9%/73.1%, D3-RDP: 7.7%/0%. There is a significant change in OS/DFS in the D3-RDN from 2011-2013 to 2020-2022 (both P =0.046) and from 2014-2016 to 2020-2022 ( P =0.028 and P =0.005, respectively).

Conclusion: Our results indicate that surgery can achieve survival in most patients with central lymph node metastases by removing a personalized and anatomically defined D3 volume. The extent of mesenterectomy and the quality of surgery are paramount since a learning curve has demonstrated significantly improved survival over time despite the low number of patients. These results imply a place for the centralization of this patient group where feasible.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10922660PMC
http://dx.doi.org/10.1097/SLA.0000000000006099DOI Listing

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