A Nomogram for Predicting Lymph Nodes Metastasis at the Inferior Mesenteric Artery in Rectal Cancer: a Retrospective Case-control Study

Overview

Journal Updates Surg

Specialty General Surgery

Date 2024 Jan 21

PMID 38245891

Authors

Chunhao Xu

Qiaoyi Huang

Yunhuang Hu

Kai Ye

Jianhua Xu

Affiliations

Soon will be listed here.

Abstract

According to past and current literature, metastasis of the lymph nodes at the inferior mesenteric artery (IMA-LN), also known as 253LN of colorectal cancer has been seldom investigated. To date, there are still controversies on whether the 253LN need to be routinely cleaned. Using specific criteria, 347 patients who underwent radical resection for rectal cancer between April 2019 and July 2022 were selected for the study. Logistic regression was used to determine the likelihood that a patient may suffer 253LN metastasis, and a nomogram for 253LN metastasis subsequently developed. The c-index and calibration curve were used to evaluate precision and discrimination in the nomogram, and the appropriateness of the final nomogram for the clinical setting determined using decision curve analysis (DCA). 253LN metastases appeared in the pathological specimens of 29 (8.4%) of the selected patients. Logistic regression showed that preoperative parameters including serum carcinoembryonic antigen (CEA) value ( > 5 ng / ml, OR = 2.894, P = 0.023), distance from anal margin (> 9 cm, OR = 2.406, P = 0.045) and degree of differentiation (poor, OR = 9.712, P < 0.001) were significantly associated with 253LN metastasis. A nomogram to predict 253LN metastasis in rectal cancer was developed and showed considerable discrimination and good precision (c-index = 0.750). Furthermore, DCA confirmed that the nomogram has some feasibility for the clinical environment. Clinicopathological and radiological patient data can be pivotal for making surgical decisions relating to 253LN metastasis. A nomogram was developed using this data, providing an objective method that can significantly improve prognoses in colorectal cancer.

References

Saraste D, Gunnarsson U, Janson M . Predicting lymph node metastases in early rectal cancer. Eur J Cancer. 2012; 49(5):1104-8. DOI: 10.1016/j.ejca.2012.10.005. View

Matsuda K, Yokoyama S, Hotta T, Takifuji K, Watanabe T, Tamura K . Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery. Gastrointest Tumors. 2017; 4(1-2):45-52. PMC: 5649244. DOI: 10.1159/000477805. View

Bohning D, Holling H, Patilea V . A limitation of the diagnostic-odds ratio in determining an optimal cut-off value for a continuous diagnostic test. Stat Methods Med Res. 2010; 20(5):541-50. DOI: 10.1177/0962280210374532. View

Chang J, Mao Y, Feng Q, Chen Y, Wu Q, Zheng P . No.253 Lymph Nodes Metastasis in Left-Sided Colorectal Cancer Liver Metastasis (CRLM) Patients: Incidence and Prognosis. Clin Med Insights Oncol. 2022; 16:11795549221084841. PMC: 8943451. DOI: 10.1177/11795549221084841. View

Baidoun F, Elshiwy K, Elkeraie Y, Merjaneh Z, Khoudari G, Sarmini M . Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes. Curr Drug Targets. 2020; 22(9):998-1009. DOI: 10.2174/1389450121999201117115717. View

Inoue H, Sasaki K, Nozawa H, Kawai K, Murono K, Emoto S . Therapeutic significance of D3 dissection for low rectal cancer: a comparison of dissections between the lateral pelvic lymph nodes and the lymph nodes along the root of the inferior mesenteric artery in a multicenter retrospective cohort study. Int J Colorectal Dis. 2021; 36(6):1263-1270. DOI: 10.1007/s00384-021-03858-1. View

Jiang C, Liu Y, Xu C, Shen Y, Xu Q, Gu L . Pathological features of lymph nodes around inferior mesenteric artery in rectal cancer: a retrospective study. World J Surg Oncol. 2021; 19(1):152. PMC: 8132450. DOI: 10.1186/s12957-021-02264-9. View

Kang J, Hur H, Min B, Kim N, Lee K . Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer. Ann Surg Oncol. 2010; 18(3):704-10. DOI: 10.1245/s10434-010-1291-x. View

Mari G, Maggioni D, Costanzi A, Miranda A, Rigamonti L, Crippa J . "High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial" (HIGHLOW trial). Trials. 2015; 16:21. PMC: 4311448. DOI: 10.1186/s13063-014-0537-5. View

10.

Li K, Li Z, Yan B, Tan J, Chen D, Chen W . Preoperative carbon nanoparticle injection improves inferior mesenteric artery lymph node retrieval in patients with rectal cancer. Surgery. 2021; 171(5):1177-1184. DOI: 10.1016/j.surg.2021.08.023. View

11.

Mari G, Crippa J, Cocozza E, Berselli M, Livraghi L, Carzaniga P . Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection for Rectal Cancer Reduces Genitourinary Dysfunction: Results From a Randomized Controlled Trial (HIGHLOW Trial). Ann Surg. 2019; 269(6):1018-1024. DOI: 10.1097/SLA.0000000000002947. View

12.

Feng W, Zong Y, Zhao J, Li W, Miao Y, Xu Z . High versus low ligation of the inferior mesenteric artery during laparoscopic rectal cancer surgery: A prospective study of surgical and oncological outcomes. J Surg Oncol. 2021; 123 Suppl 1:S76-S80. DOI: 10.1002/jso.26362. View

13.

Munechika T, Kajitani R, Matsumoto Y, Nagano H, Komono A, Aisu N . Safety and effectiveness of high ligation of the inferior mesenteric artery for cancer of the descending colon under indocyanine green fluorescence imaging: a pilot study. Surg Endosc. 2020; 35(4):1696-1702. DOI: 10.1007/s00464-020-07556-x. View

14.

Si M, Yan P, DU Z, Li L, Tian H, Jiang W . Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis. Int J Colorectal Dis. 2019; 34(6):947-962. DOI: 10.1007/s00384-019-03291-5. View

15.

Stojkovic Lalosevic M, Stankovic S, Stojkovic M, Markovic V, Dimitrijevic I, Lalosevic J . Can preoperative CEA and CA19-9 serum concentrations suggest metastatic disease in colorectal cancer patients?. Hell J Nucl Med. 2017; 20(1):41-45. DOI: 10.1967/s002449910505. View

16.

Yang S, Su T, Huang L, Feng L, Liao T . A novel risk-predicted nomogram for sepsis associated-acute kidney injury among critically ill patients. BMC Nephrol. 2021; 22(1):173. PMC: 8111773. DOI: 10.1186/s12882-021-02379-x. View

17.

Huh J, Kim Y, Kim H . Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg. 2011; 255(1):70-8. DOI: 10.1097/SLA.0b013e31823785f6. View

18.

Zhao X, Ma J, Fu Z, Hong H, Zhang L, Xue P . Prognostic value of apical lymph node metastasis at the inferior mesenteric artery in sigmoid and rectal cancer patients who undergo laparoscopic surgery. J Surg Oncol. 2021; 123 Suppl 1:S88-S94. DOI: 10.1002/jso.26346. View

19.

Kim J, Lee K, Yu C, Kim H, Kim J, Chang H . The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer. Eur J Surg Oncol. 2004; 30(3):271-9. DOI: 10.1016/j.ejso.2003.12.002. View

20.

Fujii S, Ishibe A, Ota M, Suwa H, Watanabe J, Kunisaki C . Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (High tie vs. low tie) study. Surg Endosc. 2018; 33(4):1100-1110. DOI: 10.1007/s00464-018-6363-1. View