TY - JOUR
T1 - Clinical impact of D3 lymph node dissection with left colic artery (LCA) preservation compared to D3 without LCA preservation
T2 - Exploratory subgroup analysis of data from JCOG0404
AU - Akagi, Tomonori
AU - Inomata, Masafumi
AU - Hara, Takao
AU - Mizusawa, Junki
AU - Katayama, Hiroshi
AU - Shida, Dai
AU - Ohue, Masayuki
AU - Ito, Masaaki
AU - Kinugasa, Yusuke
AU - Saida, Yoshihisa
AU - Masaki, Tadahiko
AU - Yamamoto, Seiichiro
AU - Hanai, Tsunekazu
AU - Yamaguchi, Shigeki
AU - Watanabe, Masahiko
AU - Sugihara, Kenichi
AU - Fukuda, Haruhiko
AU - Kanemitsu, Yukihide
AU - Kitano, Seigo
N1 - Funding Information:
This study was supported in part by the National Cancer Center Research and Development Fund (23-A-16, 23-A-19, 26-A-4, and 29-A-3), Grant-in-Aid for Cancer Research (14S-3, 14S-4, 17S-3, I7S-5, 20S-3, and 20S-6), and Health and Labour Sciences Research Grant for Clinical Cancer Research (Hl5-018, H18-013, H21-017, and H24-005) from the Ministry of Health, Labour and Welfare of Japan.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Aim: We investigated the clinical impact of D3 lymph node dissection preserving left colic artery (LCA) compared to D3 without LCA preservation using data from JCOG0404. LCA preservation is expected to maintain adequate blood supply, which is effective in preventing anastomotic leakage, intestinal paralysis, and bowel obstruction. Whether D3 with LCA preservation (Group A) improves clinical outcomes following resection of sigmoid colon cancer compared to D3 without LCA preservation (Group B) is unclear. Methods: Procedure type was identified from photographs of the surgical field collected for central surgical review in JCOG0404. Clinical outcomes were compared between each procedure. Results: Among the 1057 randomized patients in JCOG0404, 631 patients receiving sigmoid colectomy or anterior resection were included in the subgroup analysis. Group A comprised of 135 patients and Group B of 496 patients. Patient backgrounds did not differ between groups. Median operative time, blood loss, anastomotic leakage, and intestinal paralysis were not remarkably different (Group A vs Group B: 185 vs 186 minutes, 60 vs 50 mL, 3.0% vs 5.0%, and 2.2% vs 3.8%). More overall postoperative complications occurred in Group B than Group A (21.6% vs 9.6%, P =.022). Five-year relapse-free survival (RFS) and overall survival (OS) tended to be better in Group A than Group B (RFS: 83.7% and 80.5%, HR 0.80 [95% CI 0.51-1.26], OS: 96.3% and 91.1%, HR 0.41 [95% CI 0.19-0.89]). Conclusions: Short- and long-term outcomes tend to be better in Group A than Group B, indicating that preservation of LCA could be an alternative treatment.
AB - Aim: We investigated the clinical impact of D3 lymph node dissection preserving left colic artery (LCA) compared to D3 without LCA preservation using data from JCOG0404. LCA preservation is expected to maintain adequate blood supply, which is effective in preventing anastomotic leakage, intestinal paralysis, and bowel obstruction. Whether D3 with LCA preservation (Group A) improves clinical outcomes following resection of sigmoid colon cancer compared to D3 without LCA preservation (Group B) is unclear. Methods: Procedure type was identified from photographs of the surgical field collected for central surgical review in JCOG0404. Clinical outcomes were compared between each procedure. Results: Among the 1057 randomized patients in JCOG0404, 631 patients receiving sigmoid colectomy or anterior resection were included in the subgroup analysis. Group A comprised of 135 patients and Group B of 496 patients. Patient backgrounds did not differ between groups. Median operative time, blood loss, anastomotic leakage, and intestinal paralysis were not remarkably different (Group A vs Group B: 185 vs 186 minutes, 60 vs 50 mL, 3.0% vs 5.0%, and 2.2% vs 3.8%). More overall postoperative complications occurred in Group B than Group A (21.6% vs 9.6%, P =.022). Five-year relapse-free survival (RFS) and overall survival (OS) tended to be better in Group A than Group B (RFS: 83.7% and 80.5%, HR 0.80 [95% CI 0.51-1.26], OS: 96.3% and 91.1%, HR 0.41 [95% CI 0.19-0.89]). Conclusions: Short- and long-term outcomes tend to be better in Group A than Group B, indicating that preservation of LCA could be an alternative treatment.
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U2 - 10.1002/ags3.12318
DO - 10.1002/ags3.12318
M3 - Article
AN - SCOPUS:85083536770
VL - 4
SP - 163
EP - 169
JO - Annals of Gastroenterological Surgery
JF - Annals of Gastroenterological Surgery
SN - 2475-0328
IS - 2
ER -