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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
 
BMC Gastroenterol. 2012; 12: 24.
Published online Mar 23, 2012. doi:  10.1186/1471-230X-12-24
PMCID: PMC3349572
Metachronous metastasis- and survival-analysis show prognostic importance of lymphadenectomy for colon carcinomas
Tilman Laubert,corresponding author1 Jens K Habermann,1 Claudia Hemmelmann,2 Markus Kleemann,1 Elisabeth Oevermann,1 Ralf Bouchard,1 Philipp Hildebrand,1 Thomas Jungbluth,1 Conny Bürk,1 Hamed Esnaashari,1 Erik Schlöricke,1 Martin Hoffmann,1 Andreas Ziegler,2 Hans-Peter Bruch,1 and Uwe J Roblick1
1Department of Surgery, Laboratory for Surgical Research, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
2Institute of Medical Biometry and Statistics, University of Lübeck, Maria-Goeppert-Straße 1, D-23562 Lübeck, Germany
corresponding authorCorresponding author.
Tilman Laubert: tlaubert/at/googlemail.com; Jens K Habermann: jens.habermann/at/gmail.com; Claudia Hemmelmann: hemmelmann/at/imbs.uni-luebeck.de; Markus Kleemann: Markus.Kleemann/at/uk-sh.de; Elisabeth Oevermann: elisabeth.oevermann/at/uk-sh.de; Ralf Bouchard: ralf.bouchard/at/chirurgie.uni-luebeck.de; Philipp Hildebrand: philipphildebrand/at/yahoo.com; Thomas Jungbluth: jungbluth-th/at/gmx.de; Conny Bürk: Conny.Buerk/at/uksh.de; Hamed Esnaashari: hamed.esnaashari/at/uk-sh.de; Erik Schlöricke: e.schloericke/at/gmx.de; Martin Hoffmann: Martin.Hoffmann/at/uk-sh.de; Andreas Ziegler: ziegler/at/imbs.uni-luebeck.de; Hans-Peter Bruch: bruch/at/uni-luebeck.de; Uwe J Roblick: DrDr.UJRoblick/at/me.com
Received December 5, 2011; Accepted March 23, 2012.
Abstract
Background
Lymphadenectomy is performed to assess patient prognosis and to prevent metastasizing. Recently, it was questioned whether lymph node metastases were capable of metastasizing and therefore, if lymphadenectomy was still adequate. We evaluated whether the nodal status impacts on the occurrence of distant metastases by analyzing a highly selected cohort of colon cancer patients.
Methods
1,395 patients underwent surgery exclusively for colon cancer at the University of Lübeck between 01/1993 and 12/2008. The following exclusion criteria were applied: synchronous metastasis, R1-resection, prior/synchronous second carcinoma, age < 50 years, positive family history, inflammatory bowel disease, FAP, HNPCC, and follow-up < 5 years. The remaining 421 patients were divided into groups with (TM+, n = 75) or without (TM-, n = 346) the occurrence of metastasis throughout a 5-year follow-up.
Results
Five-year survival rates for TM + and TM- were 21% and 73%, respectively (p < 0.0001). Survival rates differed significantly for N0 vs. N2, grading 2 vs. 3, UICC-I vs. -II and UICC-I vs. -III (p < 0.05). Regression analysis revealed higher age upon diagnosis, increasing N- and increasing T-category to significantly impact on recurrence free survival while increasing N-and T-category were significant parameters for the risk to develop metastases within 5-years after surgery (HR 1.97 and 1.78; p < 0.0001).
Conclusions
Besides a higher T-category, a positive N-stage independently implies a higher probability to develop distant metastases and correlates with poor survival. Our data thus show a prognostic relevance of lymphadenectomy which should therefore be retained until conclusive studies suggest the unimportance of lmyphadenectomy.
Keywords: Colon cancer, Lymph nodes, Metastasis, Prognosis, Survival, Recurrence free survival, Regression analysis
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