Ann Surg Treat Res.  2020 Mar;98(3):139-145. 10.4174/astr.2020.98.3.139.

Is radical surgery for clinical stage I right-sided colon cancer relevant? A retrospective review

• Kwak HD
• Ju JK
• Yeom SS
• Lee SY
• Kim CH
• Kim YJ
• Kim HR

• KMID: 2471179
• DOI: http://doi.org/10.4174/astr.2020.98.3.139

Abstract

PURPOSE
Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection.
METHODS
Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution.
RESULTS
During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors.
CONCLUSION
For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.

Keyword

Ascending colon; Colon cancer; Stage; Transverse colon

MeSH Terms

Colon*
Colon, Ascending
Colon, Transverse
Colonic Neoplasms*
Follow-Up Studies
Hospitals, Teaching
Humans
Laparoscopy
Lymph Node Excision
Lymph Nodes
Multivariate Analysis
Odds Ratio
Pathology
Recurrence
Retrospective Studies*
Risk Factors

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