Abstract
Aim
The aims of this study are to identify the natural course of inferior mesenteric artery (IMA) lymph node metastasis, and to evaluate the prognostic impact of IMA lymph node metastasis in the sigmoid colon and rectal cancer.
Patients and Methods
From our prospectively collected database, a total of 625 patients who underwent resection with curative intent for stage III adenocarcinoma of the sigmoid colon and rectal cancer between June 1995 and June 2007 were selected. Patients were divided into the IMA-positive group (n = 33) and the IMA-negative group (n = 592) according to IMA lymph node metastasis status. Clinicopathological features, recurrence patterns, and 5-year disease-free survival rates were compared between the two groups.
Results
Following curative resection, 5-year disease-free survival rate was 31.9% in the IMA-positive group and 69.4% in the IMA-negative group (p < 0.001). Cox regression analysis revealed that rectal cancer, pathologic stage, and presence of IMA lymph node metastasis were independently associated with disease-free survival. Systemic recurrence rate was significantly higher in the IMA-positive group than in the IMA-negative group (48.5 vs. 20.8%, respectively, p = 0.001). Para-aortic nodal recurrence showed significant association with presence of IMA lymph node metastasis on multivariate analysis (hazard ratio 11.8; 95% confidence interval 2.7–52.2, p = 0.001).
Conclusion
Presence of IMA lymph node metastasis should be considered as a predictive factor for high systemic recurrence, and should be treated and followed up with caution for para-aortic nodal recurrence.
Similar content being viewed by others
References
Chapuis PH, Dent OF, Fisher R, Newland RC, Pheils MT, Smyth E, et al. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg. 1985;72:698–702.
Lindmark G, Gerdin B, Pahlman L, Bergstrom R, Glimelius B. Prognostic predictors in colorectal cancer. Dis Colon Rectum. 1994;37:1219–27.
Sobin L. (2010) TNM classification of malignant tumours. Oxford: Wiley-Blackwell.
Malassagne B, Valleur P, Serra J, Sarnacki S, Galian A, Hoang C, Hautefeuille P. Relationship of apical lymph node involvement to survival in resected colon carcinoma. Dis Colon Rectum. 1993;36:645–53.
Grinnell RS. Results of ligation of inferior mesenteric artery at the aorta in resections of carcinoma of the descending and sigmoid colon and rectum. Surg Gynecol Obstet. 1965;120:1031–6.
Lange MM, Buunen M, Velde CJ, Lange JF. Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum. 2008;51:1139–45.
Kim JC, Lee KH, Yu CS, et al. The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer. Eur J Surg Oncol. 2004;30:271–9.
Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review. Dig Surg. 2008;25:148–57.
Kanemitsu Y, Hirai T, Komori K, Kato T. Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg. 2006;93:609–15.
General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg. 1983;13:557–73.
Hida J, Yasutomi M, Maruyama T, et al. Indication for using high ligation of the inferior mesenteric artery in rectal cancer surgery. Examination of nodal metastases by the clearing method. Dis Colon Rectum. 1998;41:984–7; (discussion 7–91).
Chin CC, Yeh CY, Tang R, Changchien CR, Huang WS, Wang JY. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer. Int J Colorectal Dis. 2008;23:783–8.
Min BS, Kim JS, Kim NK, Lim JS, Lee KY, Cho CH, Sohn SK. Extended lymph node dissection for rectal cancer with radiologically diagnosed extramesenteric lymph node metastasis. Ann Surg Oncol. 2009;16:3271–8.
Pezim ME, Nicholls RJ. Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg. 1984;200:729–33.
Surtees P, Ritchie JK, Phillips RK. High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg. 1990;77:618–21.
Glass RE, Ritchie JK, Thompson HR, Mann CV. The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy. Br J Surg. 1985;72:599–601.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kang, J., Hur, H., Min, B.S. et al. Prognostic Impact of Inferior Mesenteric Artery Lymph Node Metastasis in Colorectal Cancer. Ann Surg Oncol 18, 704–710 (2011). https://doi.org/10.1245/s10434-010-1291-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-010-1291-x