Segmental resection, lymph nodes dissection and survival in patients with left colon cancer.

BACKGROUND/AIMS: To evaluate retrospectively in patients who have undergone elective surgery for left colon cancer, if extent of segmental resection may affect postoperative outcome, lymph nodes dissection and long-term survival.

METHODOLOGY

With lesion localized at the sigma or descending colon, 129 patients were divided into two groups according to the length of operative specimens: group 1: 73 cases, length 8 to < or =25 cm, who were surgically treated with limited segmental resection; group 2: 56 cases, length >25 to >50 cm, who had undergone extensive segmental resection. In no patient was ligation at the root of the inferior mesenteric artery performed. Lymph node dissection of pericolic nodes (N1) and occasionally intermediate nodes (N2) in group 1 and electively of N1 and N2 nodes in group 2 was carried out.

RESULTS

Median follow-up was 60 and 56 months for group 1 and 2, respectively. In group 1 a median of 8 lymph nodes were removed compared to a median of 13 nodes retrieved in group 2, where a significant prevalence of N2 nodes was found compared to group 1 (p = 0.024). The incidence of N+ cases according to the total number of nodes removed is superimposable in the two groups. Overall disease-free survival was better, but not significantly, in group 1 compared to group 2; whereas actuarial survival curves of Dukes C cases, according to two types of resection, were similar.

CONCLUSIONS

This retrospective study shows that in patients with left colon cancer long-term survival does not seem to be significantly affected by the extent of segmental resection.