Lymph node harvesting after laparoscopic complete mesocolic excision colectomy in colon cancer with practical application of glacial acid, absolute ethanol, water, and formaldehyde solution: A prospective cohort study

Author:

Nguyen Minh Thao12ORCID,Dang Cong Thuan34,Song Nguyen Tran Bao34,Pham Nguyen Cuong5,Le Dinh Duong6,Pham Minh Duc27,Nguyen Huu Tri12,Dung Phan Dinh Tuan27,Phu Nguyen Doan Van27,Nguyen Thanh Phuc12,Doan Phuoc Vung2,Nguyen Dinh Son12,Pham Anh Vu27

Affiliation:

1. Anatomy and Surgical Training Department, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam

2. Department of Gastrointestinal Surgery, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam

3. Pathology Department, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam

4. Department of Histology, Embryology, Pathology and Forensic Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam

5. Pathology Department, Hue Central Hospital, Hue City, Vietnam

6. Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam

7. Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam

Abstract

Objectives: Quality of surgery has recently become an essential topic in the prognosis of colon cancer. Complete mesocolic excision for colon cancer has recently gained popularity with high-quality surgery. Patient specimens after complete mesocolic excision with central vessel ligation procedures have an integrity of the mesocolon and the yield of three fields of lymph node harvest. We apply the glacial acid, absolute ethanol, water, and formaldehyde solution to each specimen based on the Japanese classification of lymph node groups and station numbers. We aim to identify the distribution and status of lymph node metastasis according to each tumor site and some pathological characteristics related to this disease. Methods: A prospective cohort study was performed on 45 laparoscopic complete mesocolic excision surgery patients. Results: 2791 lymph nodes were harvested after complete mesocolic excision surgery. The average number was 62.0 ± 22.3 nodes. The mean tumor size (in the largest dimension) was 4.2 ± 1.8 cm. The average length of the resected bowel segments was 29.1 ± 7.7 cm. There are 63 (2.3%) node metastases in 2791 lymph nodes, in which 17/45 (37.8%) patients had pN(+). The minimum positive node size was 1 mm. The positive pericolic lymph nodes (station 1) accounted for the highest rate, with 53 nodes (1.9%). The number of lymph nodes in young age ⩽60 is more significant than in older. The results were similar, with a more significant node retrieval in the group with a tumor size >4.5 cm and specimen length >25 cm. The number of lymph nodes in lower tumor invasive (pT1,3) was smaller than pT4. Our research shows that the cecum, ascending, and descending colon had greater nodes than others, with a mean number of 78.6, 74.2, and 71.3, respectively. Conclusions: The metastasis and harvested lymph nodes accounted for the highest rate of colon cancer in station 1 and the lowest rate in station 3. The number of retrieved lymph nodes was significantly associated with tumor location, size, specimen length, and patient age.

Funder

Vingroup Innovation Foundation

Publisher

SAGE Publications

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