Extended resection could improve survival rates in right-sided CRC

Removing more lymph nodes during surgical resection could help improve survival rates among patients with right-sided colorectal cancer, according to research presented at the 2018 American College of Surgeons Quality and Safety Conference in Orlando.

Lawrence Lee, MD, PhD, of McGill University Health Centre in Montreal, and colleagues said their findings could lead surgeons to modify the procedures they perform on patients with right-sided colorectal tumors.

“Lymph node harvest is related to the extent of the surgical resection,” Lee said in a press release. “If removal of more lymph nodes improves survival of patients with right-sided cancer, these patients may need more extensive resection than is considered to be standard for them.”

Lee and colleagues analyzed data from the National Cancer Database on 504,958 patients who underwent surgical removal of the colon for non-metastatic colon adenocarcinoma between 2004 and 2014. They looked further to determine if the patients had right-sided (n = 273,198) or left-sided cancer (n = 231,760).

After adjusting for patient and disease characteristics and type of systemic treatment, investigators found that the overall 5-year survival rate was lower among patients with right-sided compared with left-sided CRC in both stage II (66% vs. 70%; P < .001) and stage III (56% vs. 60%; P < .001).

In patients with right-sided cancer, Lee and colleagues also found that survival rate was improved by approximately 20% when 22 or more lymph nodes were harvested during resection operations.

Lee said further prospective trials are needed to determine if extended resection high central vascular ligation — a standard procedure for patients with left-sided cancers — might be beneficial in patients with right-sided CRC.

“The kinds of vascular ligations that are required to get a greater nodal harvest on the right side mean the surgeon is dissecting around really big blood vessels. It’s a larger resection overall on that side, and the more vasculature that’s involved, the higher the risk for anastomotic breakdown and injury to these blood vessels. So, surgeons may not want to do more resection on right-sided colon cancers,” Lee said in the press release. “We don’t know the answer to the risk/reward ratio, but our study shows there’s enough of a difference in survival with greater surgical resection that we need a better understanding of the way we’re operating on the right side.” – by Alex Young

Reference:

Lawrence L, et al. Presented at: ACS Quality and Safety Conference; July 21-24, 2018; Orlando, Fla.

Disclosures: Healio Gastroenterology and Liver Disease could not confirm Lee’s relevant financial disclosures at the time of publication.