Ann Surg Treat Res.  2020 Mar;98(3):139-145. 10.4174/astr.2020.98.3.139.

Is radical surgery for clinical stage I right-sided colon cancer relevant? A retrospective review

  • 1Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.
  • 2Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.


Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection.
Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution.
During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors.
For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.


Ascending colon; Colon cancer; Stage; Transverse colon

MeSH Terms

Colon, Ascending
Colon, Transverse
Colonic Neoplasms*
Follow-Up Studies
Hospitals, Teaching
Lymph Node Excision
Lymph Nodes
Multivariate Analysis
Odds Ratio
Retrospective Studies*
Risk Factors


1. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010; 28:272–278. PMID: 19949013.
2. Kawamura YJ, Sakuragi M, Togashi K, Okada M, Nagai H, Konishi F. Distribution of lymph node metastasis in T1 sigmoid colon carcinoma: should we ligate the inferior mesenteric artery? Scand J Gastroenterol. 2005; 40:858–861. PMID: 16109663.
3. Choi PW, Yu CS, Jang SJ, Jung SH, Kim HC, Kim JC. Risk factors for lymph node metastasis in submucosal invasive colorectal cancer. World J Surg. 2008; 32:2089–2094. PMID: 18553050.
4. Huh JW, Kim HR, Kim YJ. Lymphovascular or perineural invasion may predict lymph node metastasis in patients with T1 and T2 colorectal cancer. J Gastrointest Surg. 2010; 14:1074–1080. PMID: 20431977.
5. Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018; 23:1–34. PMID: 28349281.
6. Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, et al. NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Canc Netw. 2018; 16:359–369. PMID: 29632055.
7. Labianca R, Nordlinger B, Beretta GD, Mosconi S, Mandala M, Cervantes A, et al. Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6:vi64–vi72. PMID: 24078664.
8. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015; 20:207–239. PMID: 25782566.
9. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009; 11:354–364. PMID: 19016817.
10. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002; 45:200–206. PMID: 11852333.
11. Beaton C, Twine CP, Williams GL, Radcliffe AG. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis. 2013; 15:788–797. PMID: 23331927.
12. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg. 1983; 13:557–573. PMID: 6672390.
13. Ovrebo K, Rokke O. Extended lymph node dissection in colorectal cancer surgery. Reliability and reproducibility in assessments of operative reports. Int J Colorectal Dis. 2010; 25:213–222. PMID: 19865821.
14. Storli KE, Sondenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I, et al. Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol. 2014; 18:557–564. PMID: 24357446.
15. Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A, et al. Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study? Int J Colorectal Dis. 2014; 29:89–97. PMID: 23982425.
16. Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol. 2015; 16:161–168. PMID: 25555421.
17. Willaert W, Ceelen W. Extent of surgery in cancer of the colon: is more better? World J Gastroenterol. 2015; 21:132–138. PMID: 25574086.
18. Zheng M, Ma J, Fingerhut A, Adamina MP, Atroschenko A, Bergamaschi R, et al. Complete mesocolic excision for colonic cancer: Society for Translational Medicine expert consensus statement. Ann Laparosc Endosc Surg. 2018; 3:68.
19. Lu JY, Xu L, Xue HD, Zhou WX, Xu T, Qiu HZ, et al. The Radical Extent of lymphadenectomy - D2 dissection versus complete mesocolic excision of LAparoscopic Right Colectomy for right-sided colon cancer (RELARC) trial: study protocol for a randomized controlled trial. Trials. 2016; 17:582. PMID: 27931247.
20. International Prospective Observational Cohort Study for Optimal Bowel Resection Extent and Central Radicality for Colon Cancer (T-REX). identifier: NCT02938481 [Internet]. Bethesda (MD):;cited 2019 Jul 9. Available from:
Full Text Links
  • ASTR
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: