title: A radiological and pathological assessment of ileocolic pedicle length as a predictor of lymph node retrieval following right hemicolectomy for caecal cancer.
abstract: BACKGROUND
  In colon cancer, the number of harvested lymph nodes is critical for pathological staging. It has been proposed that the more central the mesenteric vascular ligation, the greater the nodal yield. The aim of the current study was to determine the association of radiological and pathological ileocolic pedicle length on nodal harvest following right hemicolectomy for caecal cancer.
  
  
  METHODS
  A series of 50 patients undergoing right hemicolectomy for adenocarcinoma underwent specimen evaluation. Preoperative computed tomography images were reconstructed and analysed to determine the direct (vessel origin to caecum) ileocolic pedicle length.
  
  
  RESULTS
  The median pathological distance from the tumour to the high vascular tie was 80 mm, and median nodal yield was 16.5 nodes. Radiological pedicle length did not correlate with the pathological distance from the tumour to the high vascular tie or nodal yield; however, the pathological pedicle length did correlate with the total nodal yield (r (2): 0.343, p = 0.015). The median pathologically determined length of colon resected (r (2): 0.153, p = 0.289), ileum resected (r (2): 0.087, p = 0.568) and total specimen length resected (r (2): 0.182, p = 0.205) did not correlate with the total nodal yield. An ileal specimen length ≤25 mm [hazard ratio (HR) 14.8, 95 % confidence interval (CI) 1.1-194.5, p = 0.040] and a well-differentiated tumour (HR 10.5, 95 % CI 1.1-95.9, p = 0.037) increased the likelihood of retrieving <12 lymph nodes.
  
  
  CONCLUSIONS
  Based on these data, pathologic pedicle length is a determining factor in lymph node retrieval. Preoperative radiological calculation of pedicle length does not help predict the number of lymph nodes retrieved.
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.|Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: J G
authors.initials: JG
authors.lastname: Solon
authors.affiliation: Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Cahalane
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.|Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: J P
authors.initials: JP
authors.lastname: Burke
authors.affiliation: Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Gibbons
authors.affiliation: Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: J W
authors.initials: JW
authors.lastname: McCann
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.|Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: S T
authors.initials: ST
authors.lastname: Martin
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.|Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Sheahan
authors.affiliation: Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. deswinter@gmail.com.|Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. deswinter@gmail.com.
authors.forename: D C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D002430:Cecal Neoplasms / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000098:blood supply / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000098:blood supply / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D060787:Neoplasm Grading; D009929:Organ Size; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Colon cancer; Lymph node metastasis; Radiological assessment of ileocolic pedicle