Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement

Objective: To find out what effect the extent of nodal dissection has on patients with operable colonic cancer. Design: Retrospective study. Setting: Teaching hospital, Japan. Patients: 564 consecutive patients who had potentially curative operations for colon cancer. Patients treated by limited nodal dissection, in which only pericolonic nodes were dissected, were excluded. Main outcome measures: Disease free survival classified by extent of nodal dissection. Results: High ligation gave no significant advantage when patients were subgrouped according to degree of nodal involvement. However, number of patients with aggressive involvement (including intermediate or central nodes) was small. 511 patients (91%) had limited nodal involvement (no nodal involvement or nodal involvement confined to pericolonic nodes). High ligation of the vessels gave no advantage even with meticulous subgrouping according to age, site, and depth of invasion. Conclusion: Most patients with colonic cancer had limited nodal involvement. High ligation did not affect the long term results in these patients, so, less invasive low ligation should be considered. A larger study will be necessary to clarify the indications for low and high ligation for patients with aggressive nodal involvement.