Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press13010.17650/2220-3478-2015-5-2-7-13REVIEWОБЗОРЫ ЛИТЕРАТУРЫSelection of surgical approach and role of lymph node dissection at colorectal cancerВыбор хирургической тактики и роль лимфодиссекции при колоректальном ракеMelnikovP. V.МельниковП. В.
Russian Federation
drmelnikov84@gmail.comSavenkovS. V.СавенковС. В.
Russian Federation
Moscow Regional Oncologic DispensaryГБУЗ МО «Московский областной онкологический диспансер»6 Karbysheva St., Balashikha, Moscow region, 143900, RussiаРоссия, 143900, Московская область, Балашиха, ул. Карбышева, 617072015527131707201517072015Copyright ©; 2015, Melnikov P.V., Savenkov S.V.Copyright ©; 2015, Мельников П.В., Савенков С.В.2015Melnikov P.V., Savenkov S.V.Мельников П.В., Савенков С.В.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/130

Historically, colorectal surgeons extended lymph nodes dissection level. However, it is still controversial issues: what is considered to be an extended lymph node dissection, why and to whom it is better to do it, etc. Moreover, the prognostic value of extended lymph dissection was demonstrated in trials with a low level of evidence and has different degrees of recommendation in different countries and regions. On one hand positive apical lymph nodes in colon cancer achieves 17 % and its risk increasing with tumor penetration into bowel wall, and it is an independent negative prognostic factor with 5 years overall surveillance less 45 %. An indirect data (increased the number of lymph nodes, integrity of removed mesocolon, lymphovascular length, etc.) showed better outcomes with extended lymph node dissection. More controversy is extended lymph node dissection for rectal cancer, the current standard of treatment which is at chemoradiotherapy and/or total mesorectumectomy for T3–4N0–2. Because there is no evidence that lateral pelvic node dissection in rectal cancer improves disease-free survival and overall survival, as well as high ligation of the inferior mesenteric artery. And the presence of pelvic and inferior mesenteric lymph node metastases, identifying average in 7 %, is associated with a high level of local recurrences till 44 % and low survival rate not more 42 % in 5 years. The answer to this question may be conducting multicenter randomized trials. 

rectal cancercolon cancerextended D3 lymph nodes dissectionlateral pelvic nodes dissectiontotal mesorectal exisioncomplete mesocolon excisionapical lymph nodeshigh IMA ligationstage migrationlymphovascular lengthрак прямой кишкирак ободочной кишкирасширенная D3-лимфодиссекциялатеральная тазовая лимфодиссекциятотальная мезоректумэктомияполная мезоколонэктомияапикальные лимфатические узлывысокая перевязка нижней брыжеечной артериимиграция стадии1. Ачкасов Е.Е., Мельников П.В., Алекперов С.Ф., Каннер Д.Ю. Эволюция подходов к лечению рака толстой кишки, осложненного толстокишечной непроходимостью. Хирург 2012;3:54–62. [Achkasov E.E., Melnikov P.V., Alekperov S.F., Kanner D.Yu. Evolution of approaches to the management of colon cancer complicated by colonic obstruction. Khirurg = Surgeon 2012;3:54–62. (In Russ.)].Ачкасов Е.Е., Мельников П.В., Алекперов С.Ф., Каннер Д.Ю. Эволюция подходов к лечению рака толстой кишки, осложненного толстокишечной непроходимостью. Хирург 2012;3:54–62. [Achkasov E.E., Melnikov P.V., Alekperov S.F., Kanner D.Yu. Evolution of approaches to the management of colon cancer complicated by colonic obstruction. Khirurg = Surgeon 2012;3:54–62. (In Russ.)].2. Corman M. Colon and rectal surgery. 5th ed. Philadelphia, PA: Lippincott, Williams and Wilkins, 2005. P. 1141.Corman M. Colon and rectal surgery. 5th ed. Philadelphia, PA: Lippincott, Williams and Wilkins, 2005. P. 1141.3. Baxter N.N., Virnig D.J., Rothenberger D.A. et al. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97(3):219–25.Baxter N.N., Virnig D.J., Rothenberger D.A. et al. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97(3):219–25.4. Sauer I., Bacon H.E. Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis. Am J Surg 1951;81:111–20.Sauer I., Bacon H.E. Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis. Am J Surg 1951;81:111–20.5. Bacon H.E., Dirbas F., Myers T.B., Ponce de Leon F. Extensive lymphadenectomy and high ligation of the inferior mesenteric artery for carcinoma of the left colon and rectum. Dis Colon Rectum 958;1(6): 457–64.Bacon H.E., Dirbas F., Myers T.B., Ponce de Leon F. Extensive lymphadenectomy and high ligation of the inferior mesenteric artery for carcinoma of the left colon and rectum. Dis Colon Rectum 958;1(6): 457–64.6. Turnbull R.B., Kyle K., Watson F.R., Spratt J. Cancer of the colon: the influence of the notouch technik on the survival rate. Ann Surg 1967;166(3):420–7.Turnbull R.B., Kyle K., Watson F.R., Spratt J. Cancer of the colon: the influence of the notouch technik on the survival rate. Ann Surg 1967;166(3):420–7.7. Wiggers T., Jeekel J., Arends J.W. et al. No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg 1988;75(5):409–15.Wiggers T., Jeekel J., Arends J.W. et al. No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg 1988;75(5):409–15.8. Toyota S., Ohta H., Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 1995;38(7):705–11.Toyota S., Ohta H., Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 1995;38(7):705–11.9. Alici A., Kement M., Gezen C. et al. Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer: an analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity. Tech Coloproctol 2010;14(1):1–8.Alici A., Kement M., Gezen C. et al. Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer: an analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity. Tech Coloproctol 2010;14(1):1–8.10. Chin C.C., Yeh C.Y., Tang R. et al. 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(8):783–8.Chin C.C., Yeh C.Y., Tang R. et al. 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(8):783–8.11. Kang J., Hur H., Min B.S. et al. Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer. Ann Surg Oncol 2011;18(3):704–10.Kang J., Hur H., Min B.S. et al. Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer. Ann Surg Oncol 2011;18(3):704–10.12. Yi J.W., Lee T.G., Lee H.S. Apical-node metastasis in sigmoid colon or rectal cancer: is it a factor that indicates a poor prognosis after high ligation? Int J Colorectal Dis 2012;27(1):81–7.Yi J.W., Lee T.G., Lee H.S. Apical-node metastasis in sigmoid colon or rectal cancer: is it a factor that indicates a poor prognosis after high ligation? Int J Colorectal Dis 2012;27(1):81–7.13. Storli K.E., Søndenaa K., Furnes B. et al. Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I–II. Tech Coloproctol 2014;18(6):557–64.Storli K.E., Søndenaa K., Furnes B. et al. Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I–II. Tech Coloproctol 2014;18(6):557–64.14. Malassagne B., Valleur P., Serra J. Relationship of apical lymph node involvement to survival in resected colon carcinoma. Dis Colon Rectum 1993;36(7):645–53.Malassagne B., Valleur P., Serra J. Relationship of apical lymph node involvement to survival in resected colon carcinoma. Dis Colon Rectum 1993;36(7):645–53.15. Japanese Society for Cancer of the Colon and Rectum. General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus. 7th ed. Tokyo: Kanehara & Co. Ltd, 2006.Japanese Society for Cancer of the Colon and Rectum. General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus. 7th ed. Tokyo: Kanehara & Co. Ltd, 2006.16. Wang J.P. Chinese standard for the diagnosis and treatment of colorectal cancer (2010). Zhonghua Wei Chang Wai Ke Za Zhi 2011;14(1):1–4.Wang J.P. Chinese standard for the diagnosis and treatment of colorectal cancer (2010). Zhonghua Wei Chang Wai Ke Za Zhi 2011;14(1):1–4.17. Hohenberger W., Weber K., Matzel K. et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome. Colorectal Dis 2009;11(4):354–65.Hohenberger W., Weber K., Matzel K. et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome. Colorectal Dis 2009;11(4):354–65.18. West N.P., Hohenberger W., Weber K. et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010;28(2):272–8.West N.P., Hohenberger W., Weber K. et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010;28(2):272–8.19. West N.P., Kobayashi H., Takahashi K. et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 2012;30(15):1763–9.West N.P., Kobayashi H., Takahashi K. et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 2012;30(15):1763–9.20. Killeen S., Mannion M., Devaney A., Winter D.C. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis 2014;16(8):577–94.Killeen S., Mannion M., Devaney A., Winter D.C. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis 2014;16(8):577–94.21. Fujita S., Yamamoto S., Akasu T., Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 2003;90(12):1580–5.Fujita S., Yamamoto S., Akasu T., Moriya Y. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 2003;90(12):1580–5.22. Sugihara K., Moriya Y., Akasu T., Fujita S. Pelvic autonomic nerve preservation for patients with rectal carcinoma: oncologic and functional outcome. Cancer 996;78: 1871–80.Sugihara K., Moriya Y., Akasu T., Fujita S. Pelvic autonomic nerve preservation for patients with rectal carcinoma: oncologic and functional outcome. Cancer 996;78: 1871–80.23. Takahashi T., Ueno M., Azekura K., Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 2000;43(10 Suppl):S59–68.Takahashi T., Ueno M., Azekura K., Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 2000;43(10 Suppl):S59–68.24. Ueno H., Mochizuki H., Hashiguchi Y. et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 2007;245(1):80–7.Ueno H., Mochizuki H., Hashiguchi Y. et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 2007;245(1):80–7.25. Kim T.H., Jeong S.Y., Choi D.H. et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 2008;15(3):729–37.Kim T.H., Jeong S.Y., Choi D.H. et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 2008;15(3):729–37.26. Kobayashi H., Mochizuki H., Kato T. et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum 2009;52(4):567–76.Kobayashi H., Mochizuki H., Kato T. et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum 2009;52(4):567–76.27. Fujita S., Akasu T., Mizusawa J. et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 2012;13(6):616–21.Fujita S., Akasu T., Mizusawa J. et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 2012;13(6):616–21.28. van Gijn W., Marijnen C.A., Nagtegaal I.D. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011;12(6):575–82.van Gijn W., Marijnen C.A., Nagtegaal I.D. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011;12(6):575–82.29. Kim J.C., Takahashi K., Yu C.S. et al. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 2007;246(5):754–62.Kim J.C., Takahashi K., Yu C.S. et al. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 2007;246(5):754–62.30. Huh J.W., Kim Y.J., Kim H.R. Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg 2012;255(1):70–8.Huh J.W., Kim Y.J., Kim H.R. Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg 2012;255(1):70–8.31. 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(5):609–15.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(5):609–15.32. Uehara K., Yamamoto S., Fujita S. et al. Impact of upward lymph node dissection on survival rates in advanced lower rectal carcinoma. Dig Surg 2007;24(5):375–81.Uehara K., Yamamoto S., Fujita S. et al. Impact of upward lymph node dissection on survival rates in advanced lower rectal carcinoma. Dig Surg 2007;24(5):375–81.33. Chang Y.J., Chang Y.J., Chen L.J. et al. Evaluation of lymph nodes in patients with colon cancer undergoing colon resection: a population-based study. World J Surg 2012;36(8):1906–14.Chang Y.J., Chang Y.J., Chen L.J. et al. Evaluation of lymph nodes in patients with colon cancer undergoing colon resection: a population-based study. World J Surg 2012;36(8):1906–14.34. Ефетов С.К., Тулина И.А., Кравченко А.Ю. и др. Отдаленные результаты лечения рака правой половины ободочной кишки с применением мезоколонэктомии и D3-лимфодиссекции. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2014;24(1):62–70. [Efetov S.K., Tulina I.A., Kravchenko A.Yu. et al. Long-term results of cancer management in the right colon with administration of mesocolonectomy and D3-lymph node dissection. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology 2014;24(1):62–70. (In Russ.)].Ефетов С.К., Тулина И.А., Кравченко А.Ю. и др. Отдаленные результаты лечения рака правой половины ободочной кишки с применением мезоколонэктомии и D3-лимфодиссекции. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2014;24(1):62–70. [Efetov S.K., Tulina I.A., Kravchenko A.Yu. et al. Long-term results of cancer management in the right colon with administration of mesocolonectomy and D3-lymph node dissection. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology 2014;24(1):62–70. (In Russ.)].