The mesenteric and antimesenteric location of colorectal cancer: the relationship with lymph nodes

Luminal mapping reveals mesenteric predominance of colonic adenomas and adenocarcinomas

BACKGROUND

Previous studies have examined the relationship between colorectal tumor distribution and metastasis, but the tumor luminal location and associative risk factors promoting tumor growth remain unknown.

METHODS

In this study, we mapped the luminal distribution of human colonic adenomas/adenocarcinomas and their association with various physiologic parameters.

RESULTS

We identified a mesenteric predominance for colonic adenomas and adenocarcinomas.

CONCLUSION

The findings of this study raise the possibility of novel mechanistic pathways in the development of adenomas and subsequent transformation into adenocarcinomas.

A pilot study to investigate if the mesenteric circumferential location of colon cancer affects survival when compared to the anti-mesenteric side

Colorectal cancer is a leading cause of death in the western world. The main datum that is employed to guide treatment and prognosis are related to the pathological stage and the genetics of the cancer. Recent electron-microscopic study of the colonic border has suggested a difference between the micro-anatomy of the mesenteric border¹¹, compared to the anti-mesenteric. With colorectal cancer increasing in incidence, the more information that we can employ to guide and tailor patient centred management, the better. A pilot study to test the hypothesis that the circumferential location on the colonic wall, mesenteric or anti-mesenteric, has an impact on the mortality rate associated with right-sided colon cancer. All patients undergoing a right hemicolectomy for non-metastatic adenocarcinoma between 2010 and 2013 were included (155 patients in total). T and N stage were recorded. There was no statistical difference between the groups for age or sex. Survival rates were then calculated according to the location of the cancer and analysed using Kaplan-Meir survival calculations. 100 patients were included in the final analysis. 90 patients had cancer on the antimesenteric border. The T and N stage were not statistically different between the two groups. The mean all-cause survival was 44 months for the mesenteric group and 77 for the antimesenteric (P = 0.002). Disease free survival was 41 versus 60 months accordingly (P = 0.021). Mesenteric cancer appears to have a shorter survival time, and may be a good candidate for future prognostication and treatment algorithms. Interesting this survival difference is observed even with a lower average T stage in the mesenteric group. The histological recording of the circumferential location is a zero cost and easy metric to record.

The mesenteric and antimesenteric site of the tumor as possible prognostic factor in colorectal cancer: 5-year survival analysis

INTRODUCTION

Colorectal cancer is still one of the many factors of death both in males and in females. To date, the most important prognostic factors are mainly related to the pathological stage of the disease.

AIM OF THE STUDY

The purpose of this study was to analyze the possible role of tumor circumferential localization on the colonic wall (mesenteric (M) or antimesenteric (AM)) as a possible prognostic factor. In this study, we compare the localization of the tumor with patient's survival. The hypothesis of this study is that M tumors, closer to blood and lymphatic vessels, should be more aggressive in terms of hematogenous and lymphatic spread compared to the AM tumors.

PATIENTS AND METHODS

All patients undergoing curative resection for colorectal cancer were enrolled in this study; there was no statistical difference for age, sex and co-morbidity. The histopathological examination was carried out in the standard manner. Next, we have taken care to survival of neoplastic patients by examining of our 5-year follow-up archive: we divided patients in different groups concerning the different tumor stage and we compare these results with the different localizations of tumor at the operation.

RESULTS

In 45% of cases, we were able to distinguish the different localizations M (160 patients) or AM (47 patients) and this difference is statistically significant (P<0.0001, Pearson Chi-Square-test (PCS-t)). The number of metastatic nodes is statistically higher in the M group compared to the AM group one (P=0.003949). Medium time of follow-up was 36.54 months; AM and M patients have a rather similar survival, only at the end the two curves seem to change but not in a significant manner. Only if we consider the difference between the two groups comparing T3 tumor can we observe a statistically significant difference (P<0.005).

CONCLUSIONS

In conclusion, the localization of M or AM colorectal cancer is feasible in 45% of cases. M tumors have significantly more lymph nodes metastases but a better 5-year survival than AM tumors. A possible explanation for such results might be the different pattern of diffusion of cancer cells.

Injection of colorectal cancer cells in mesenteric and antimesenteric sides of the colon results in different patterns of metastatic diffusion: an experimental study in rats

Background

This experimental study was designed to investigate the differences in pattern of local growth and diffusion of colorectal cancer cells injected into either mesenteric (M) or antimesenteric (AM) sides of the colon.

Methods

A total of 1 × 10⁶ colonic adenocarcinoma cells (line DHD/K12-TRb) were injected into the cecal wall of BDIX syngeneic male rats at an M or AM site of the colon. At six weeks after injection, all animals were sacrificed and the presence or absence of tumor in the cecum as well as regional metastasis and peritoneal carcinomatosis were determined.

Results

Six weeks after injection, macroscopic tumor growth was observed in 27/37 (72%) animals in group M and 21/32 (65%) in group AM (P = 0.98). In group AM, diffuse peritoneal carcinomatosis was present in 19/21 rats (90.4%) versus 3/27 rats (11%) in group M; this difference was statistically significant (P = 0.025). Regional mesenteric lymph nodes were the only location in which tumor was detected in 23/27 rats (85%) in group M versus 2/21 (9.5%) in group AM; this difference too was statistically significant (P = 0.031)

Conclusion

The patterns of diffusion of tumors implanted in mesenteric and antimesenteric sites of the colon appear to be different, although the reason for this is not clear.