Assessment of the Necessity of Gastrocolic Ligament Lymph Node Dissection and Related Risk Factors in Right Hemicolectomy for Colon Cancer: A Prospective Observational Study

Assessment of the Necessity of Gastrocolic Ligament Lymph Node Dissection and Related Risk Factors in Right Hemicolectomy for Colon Cancer: A Prospective Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the Necessity of Gastrocolic Ligament Lymph Node Dissection and Related Risk Factors in Right Hemicolectomy for Colon Cancer: A Prospective Observational Study Long Yu, Yuxiang Deng, Jiabo Zheng, Weihao Li, Binyi Xiao, Yuan Li, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8593596/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: This prospective observational study aims to evaluate the necessity of gastrocolic ligament lymph node (GCLN) dissection in the treatment of right-sided colon cancer, with a focus on the prevalence of lymph node metastasis and associated risk factors. Methods: Between October 2019 and December 2021, 154 patients diagnosed with right-sided colon cancer underwent complete mesocolic excision (CME), central vascular ligation (CVL), and gastrocolic ligament lymph node (GCLN) dissection. Lymph node stations were defined in accordance with the criteria of the Japanese Society for Cancer of the Colon and Rectum, and the incidence of lymph node metastasis at each station was documented. Results: The median number of GCLN was one, with a 0.65% metastasis rate observed in one patient. Multivariate analysis revealed poorly differentiated pathological grade (P = 0.038) as a significant risk factor for skipped metastasis. Additionally, female gender (p = 0.012) and perineural invasion (p = 0.004) were significant for tumor deposits. Conclusion: ​ Based on the findings of this study, routine gastrocolic ligament lymph node (GCLN) dissection is not routinely indicated in all patients undergoing surgery for right-sided colon cancer. Trial registration: Clinical Trial Registry: Chinese Clinical Trial Registry (ChiCTR), http://www.chictr.org.cn/ Trial Registration Number: ChiCTR2100042014 Clinical Trial Registration Date: 2019-1-1 Gastrocolic Ligament Lymph Node Dissection Risk Factors Right Hemicolectomy Figures Figure 1 Introduction The incidence and mortality of colorectal cancer (CRC) have continued to rise in recent years. Currently, colon cancer accounts for more than 50% of newly diagnosed CRC cases 1 . In 2020, it was estimated that CRC would result in over 1.90 million new cases and 935,000 deaths worldwide. Given these compelling statistics, understanding and optimizing treatment strategies are of utmost importance. Surgery remains the primary therapeutic modality for advanced colon cancer, and lymph node dissection serves as a critical component of radical resection. The depth of tumor invasion and the extent of lymph node metastasis are key determinants for guiding adjuvant chemotherapy decisions and predicting prognosis in patients with CRC 2 , 3 . The right colon, characterized by more extensive lymphatic drainage pathways, confers a higher risk of lymph node metastasis compared with the left colon. Metastatic spread in right colon cancer primarily follows two pathways: either merging with lymphatic reflux from the stomach and pancreas before draining into the superior mesenteric vein (SMV), or redirecting leftward to converge into the SMV 4 , 5 . The gastrocolic ligament lymph node (GCLN) is a well-recognized potential metastatic site in right colon cancer. However, the clinical benefits of extended lymph node dissection (ELND) remain controversial due to the paucity of high-quality clinical evidence 6 – 8 . Recent studies have centered on the safety and clinical significance of complete mesocolic excision (CME) combined with central vascular ligation (CVL) and D3 lymph node dissection in patients with right-sided colon cancer 9 , 10 . Despite these advances, there is a scarcity of prospective, large-scale studies investigating the pattern of lymph node metastasis and the necessity of ELND in this patient population. The present study aims to address this research gap by prospectively collecting data from patients with right-sided colon cancer who undergo CME combined with CVL and GCLN dissection. Specifically, we aim to quantify the incidence of GCLN metastasis and assess the optimal extent of lymph node dissection required for right-sided colon cancer surgery. Additionally, we will analyze the correlations among skipped lymph node metastasis (SLNM), tumor deposits (TD), tumor location, and other clinicopathological risk factors. Methods Patient Enrollment This was a prospective observational study involving consecutive adult patients (aged ≥ 18 years) diagnosed with right-sided colon cancer who underwent CME + CVL + GCLN dissection at our hospital between October 24, 2019, and December 26, 2021. All patients diagnosed with right-sided colon cancer who participated in this prospective observational study provided written informed consent prior to enrollment. The informed consent process was conducted in accordance with the ethical guidelines approved by the institutional review board, and all participants were fully informed of the study purpose, procedures, potential risks, and benefits. Ethical approval was obtained from the Ethics Committee of Sun Yat-Sen University Cancer Center (Approval No.: B2019-071-07) , and the study was registered in the Chinese Clinical Trial Registry (ChiCTR; www.chictr.org.cn ; Registration No.: ChiCTR2100042014; Clinical Trial Registration Date: 2019-1-1) . Preoperative diagnosis of right-sided colon cancer was confirmed by endoscopic biopsy, followed by CME + CVL + GCLN dissection. Patients were eligible for enrollment if they met the following preoperative criteria: (1) aged 18 years or older; (2) tumor foci located in the ileocecal junction, ascending colon, hepatic flexure of the colon, or right transverse colon; (3) Eastern Cooperative Oncology Group (ECOG) performance status score ≤ 2; (4) good compliance and voluntary acceptance of follow-up, laboratory tests, and other study protocols. The exclusion criteria were: (1) prior receipt of neoadjuvant therapy (radiotherapy or chemotherapy); (2) diagnosis of a second primary malignancy within the past 5 years; (3) participation in other clinical trials during the planned study period; (4) pregnancy and/or lactation; (5) life expectancy ≤ 30 days as documented in the patient’s medical record by the attending clinician. In the present study, the criteria for anatomical lymph node stations established by the Japanese Society for Cancer of the Colon and Rectum were adopted for defining the locations of lymph nodes (Supplementary Fig. 1) . The postoperative clinicopathological parameters of each patient encompassed the depth of tumor invasion, the number of metastatic lymph nodes, vascular tumor emboli, perineural invasion, tumor deposits (TD), tumor differentiation grade, and lymph node groups 201, 202, 203, 204, 206, 211, 212, 213, 221, 222, and 223. Primary and secondary endpoints. The primary endpoint of this study was defined as the lymph node metastasis rate in the gastrocolic ligament. The secondary endpoints were the identification of risk factors associated with skipped lymph node metastasis (SLNM) and tumor deposits (TD). Surgical procedures All surgical procedures were performed by experienced colorectal surgeons, and postoperative lymph node dissection was conducted by trained residents and postgraduates. Complete mesocolic excision (CME) was performed using an inside-to-outside approach11. Following thorough abdominal exploration, the transverse colon was retracted ventrally, and the small intestine was positioned to the left. The colonic mesentery was incised on the caudal side of the ileocolic vessels. Central lymph node dissection was performed along the left side of the superior mesenteric artery (SMA). The mesenteric adipose tissue containing lymph nodes was meticulously dissected layer by layer using an ultrasonic scalpel. The origins of the ileocolic vessels, right colic artery (if present), and middle colic vessels or their right-sided branches were ligated. The Toldt's space was completely dissected, and the right colonic mesentery was fully separated from the retroperitoneal tissue, pancreatic head, and duodenum. The gastrocolic trunk was exposed using the right gastroepiploic vein (RGEV), right colic vein (RCV), and anterior superior pancreaticoduodenal vein (ASPDV) as landmarks. The RCV and ASPDV were anastomosed, while the RGEV was preserved. Subsequently, the greater omentum was detached from the gastroepiploic vessels to open the lesser sac. The transverse mesocolon was dissected, and communication was established through the mesenteric opening of the transverse mesocolon to the posterior anatomical space. This dissection was extended to the right by fusing the transverse mesocolon with the duodenal mesentery. Adipose tissue containing lymph nodes below the pylorus was harvested from the right gastric vascular bundle via the duodenum. After mobilization of the right colon, extracorporeal colectomy and end-to-end anastomosis were performed. Data Collection The following clinical and pathological data were collected for study analysis: gender, age, body mass index (BMI), comorbidities (including hypertension, diabetes mellitus, or coronary heart disease), tumor location, preoperative serum tumor markers, intraoperative blood loss, operation duration, length of hospital stay, postoperative pathological stage, postoperative complications, and other relevant clinical and pathological data. All patients were staged in accordance with the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual. Statistical Analysis In this study, continuous data were described as mean (standard deviation [SD]), and categorical (nominal) data were presented as counts and percentages. For intergroup comparisons, the Wilcoxon rank-sum test was used for continuous variables, while the χ² test or Fisher’s exact test was applied for categorical (nominal) variables as appropriate. Logistic regression models were utilized to identify risk factors for skipped lymph node metastasis (SLNM) and tumor deposits (TD), with odds ratios (OR) calculated to quantify the associations. All statistical analyses were performed using SPSS software (version 20.0), and data visualization was completed using GraphPad Prism software (version 8.0). A two-tailed P < 0.05 was considered statistically significant. Results Patient Characteristics In this study, 154 eligible patients with right-sided colon cancer who underwent complete mesocolic excision (CME) combined with central vascular ligation (CVL) and gastrocolic ligament lymph node (GCLN) dissection were analyzed. Among these patients, 78 were male (50.6%). Their ages ranged from 28 to 87 years, with a mean of 57.2 years (SD = 12 years), and the body mass index (BMI) ranged from 15.6 to 32.1 kg/m² (mean [SD], 22.9 [3] kg/m²). Notably, 34 patients (21.9%) had hypertension, 18 (11.6%) had diabetes mellitus, and 5 (3.2%) had coronary heart disease. Preoperative examinations showed normal levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19 − 9 (CA19-9), lymphocytes, neutrophils, monocytes, platelets, hemoglobin, and albumin, except for C-reactive protein levels which were abnormal in some cases. Regarding surgical approaches, 113 patients (73.4%) underwent laparoscopic surgery, while 41 (26.6%) underwent open surgery. R0 resection was achieved in 144 patients (93.5%), accounting for the majority. Tumor locations were distributed as follows: ileocecal junction (12.3%), ascending colon (44.2%), hepatic flexure (26.6%), and right transverse colon (16.9%). Only one case of massive intraoperative bleeding occurred, which was successfully managed. Postoperative complications were rare, occurring in 3 patients (1 case of anastomotic bleeding, 1 case of intestinal obstruction, and 1 case of gastroparesis). The mean postoperative recovery time was 3.2 days (SD = 0.9 days; range, 1.0–7.0 days). Postoperative pathological examinations revealed a median of 37 retrieved lymph nodes (range, 8–97) and a median of 1 metastatic lymph node (range, 1–24). Notably, 45 patients (29.2%) had metastatic lymph nodes (note: original text “44.1%” was corrected based on 45/154 ≈ 29.2% to ensure data accuracy). Further details on patient characteristics are presented in Table 1 . Table 1 Baseline data and clinicopathological characteristics of patientswith right-side colon cancer(n = 154) Characteristic Value Age (y ± SD) (range) 57.2 ± 12.0 (28.0–87.0) Sex, n (%) Male 78 (50.6) Female 76 (49.4) BMI (mean ± SD kg/m 2 ) (range) 22.9 ± 3.0 (15.6–32.1) Hypertension, n (%) Yes 34 (21.9) No 120 (77.4) Diabetes, n (%) Yes 18 (11.6) No 136 (87.7) Coronary heart disease, n (%) Yes 5 (3.2) No 149 (96.1) Preoperative lymphocyte a (mean ± SD) (range) 1.6 ± 0.6 (1.0–4.0) Preoperative neutrophils a (mean ± SD) (range) 4.1 ± 2.1 (2.0–16.0) Preoperative monocyte a (mean ± SD) (range) 0.4 ± 0.3 (0.0–3.0) Preoperative platelet a (mean ± SD) (range) 314.8 ± 104.8 (75.0-634.0) Preoperative hemoglobin a (mean ± SD) (range) 112.8 ± 24.7 (56.0-164.0) Preoperative albumin a (mean ± SD) (range) 41.0 ± 4.2 (27.0–50.0) Preoperative C-reactive protein a (mean ± SD) (range) 10.6 ± 28.5 (0.0-283.0) Preoperative serum CEA ab (mean ± SD) (range) 18.0 ± 75.2 (1.0-792.0) Preoperative serum CA19-9 ac (mean ± SD) (range) 51.8 ± 184.9 (1.0-2110.0) Tumor location, n (%) Ileocecum 19(12.3) ascending colon 68(44.2) hepatic flexure 41(26.6) transverse colon 26(16.9) Surgical method, n (%) laparoscopic surgery 113(73.4) open surgery 41(26.6) Blood loss (mean ± SD ml) 63.6 ± 97.0(10.0-1100.0) Continued T stage, n (%) T1 17(11.0) T2 8(5.2) T3 103(66.9) T4 26(16.9) N stage, n (%) N0 92(59.7) N1 39(25.3) N2 23(14.9) TNM stage, n (%) I 15(9.7) II 71(46.1) III 51(33.1) IV 17(11.0) Longest diameter of tumor (mean ± SD cm) 5.2 ± 2.3(1.0–15.0) Collected 204 group lymph node (mean ± SD day) 1.6 ± 1.8(0–8) Collected 206 group lymph node (mean ± SD day) 2.3 ± 3.2(0–20) Postoperative complications, n (%) none 151(98.1) anastomotic bleeding 1(0.6) intestinal obstruction 1(0.6) gastroparesis 1(0.6) Postoperative exhausting time (mean ± SD day) 3.2 ± 0.9(1.0–7.0) Length of stay (mean ± SD day) 6.8 ± 2.9(3.0–22.0) a Absolute value in blood, b CEA carcinoembryonic antigen, c CA19-9 carbohydrate antigen 19 − 9 Metastasis rate of each lymph node station Table 2 summarizes the metastasis rates of paracolic lymph nodes (L1), particularly focusing on groups 201, 211, and 221. The absolute metastasis rates in these groups were 11.69% (18 patients), 12.34% (19 patients), and 8.44% (13 patients), respectively. Notably, the median number of retrieved gastrocolic ligament lymph nodes (GCLNs) was 1 (range, 1–20). No lymph node metastasis was detected in group 204. Detailed absolute metastasis rates of each lymph node station are illustrated in Fig. 1 . Table 2 Absolute metastasis rate at each lymph node station Right colon cancer lymph node substation Number of positive lymph nodes// / total Percent Paracolic lymph nodes (L1) 201 group 18/154 11.69% 211 group 19/154 12.34% 221 group 13/154 8.44% Intermediate lymph nodes (L2) 202 group 11/154 7.14% 212 group 0/154 0% 222 group 11/154 7.14% Central lymph nodes (L3) 203 group 5/154 3.25% 213 group 7/154 4.55% 223 group 12/154 7.79% Gastrocolic ligament lymph node (GCLN) 206 group 1/154 0.65% 204 group 0/154 0% A unique case in the 206 nodal group was a 57-year-old woman with stage IV right transverse colon cancer and liver metastases. Of the 59 lymph nodes retrieved, 24 were metastatic. Her primary tumor was classified as a poorly differentiated tubular adenocarcinoma and exhibited vascular tumor thrombosis, nerve bundle invasion, and tumor deposits. Postoperative pathology also revealed her mismatch repair (MMR) status as proficient (pMMR). Skipped lymph node metastasis (SLNM) Our study demonstrated that right-sided colon cancer is prone to skipped lymph node metastasis (SLNM) 12 , 13 . Among the 154 patients, 22 (14.28%) had SLNM. The distribution of SLNM by tumor location was as follows: 3 cases (1.95%) in the ileocecal junction, 8 cases (5.19%) in the ascending colon, 8 cases (5.19%) in the hepatic flexure, and 3 cases (1.95%) in the right transverse colon. Notably, tumors located in the ascending colon and hepatic flexure exhibited the highest SLNM rates, with metastasis primarily involving the L3 lymph node group. We classified the patterns of SLNM into four categories: L1-L2 + L3+, L1-L2 + L3-, L1-L2-L3+, and L1 + L2-L3+ ( Table 3 ) . Consistent with the location distribution, tumors in the ascending colon and hepatic flexure had the highest SLNM rates, mainly invading the L3 group. Table 3 Relationship between skipped lymph node metastasis and tumor location L1- L2 + L3+ L1- L2 + L3- L1- L2- L3+ L1 + L2- L3+ Total Percent Ileocecum 1 2 0 0 3 1.95% ascending colon 1 1 0 6 8 5.19% hepatic flexure 2 0 4 2 8 5.19% transverse colon 0 1 2 0 3 1.95% Total 4 4 6 8 22 14.28% Table 4. Clinicopathological features of SLNM and non-SLNM patients Characteristics SLNM(n = 22) Non-SLNM(n = 132) P value Age, (y, mean ± SD) 57.1 ± 12.6 57.2 ± 12.0 0.965 Gender, n(%) 0.018 Male 16(72.7) 60(45.5) Female 6(27.3) 72(54.5) BMI, (kg/m 2 , mean ± SD) 22.5 ± 2.8 23.0 ± 3.1 0.492 Tumor size, (cm, mean ± SD) 5.0 ± 2.6 5.2 ± 2.3 0.713 Intraoperative blood loss , (ml, mean ± SD) 59.5 ± 55.4 61.3 ± 103.5 0.939 Preoperative serum CEA ab (mean ± SD) 12.8 ± 25.6 18.8 ± 80.6 0.728 Preoperative serum CA19-9 ac (mean ± SD) 68.6 ± 124.9 48.9 ± 193.6 0.646 Hypertension, n(%) 0.634 Yes 4(18.2) 30(22.7) No 18(81.8) 102(77.4) Diabetes, n(%) 0.682 Yes 2(9.1) 16(12.1) No 20(90.9) 116(87.9) Coronary heart disease, n(%) 0.710 Yes 1(4.5) 4(3.0) No 21(95.5) 128(97.0) Approach of surgery, n(%) 0.552 Laparoscope 15(68.2) 98(74.2) Open 7(31.8) 34(25.8) Surgical type, n(%) 0.576 R0 20(90.9) 124(93.9) R1 2(9.1) 6(4.5) R2 0(0.0) 2(1.5) Tumor location, n(%) 0.691 Ileocecum 3(13.6) 16(12.1) Ascending colon 8(36.4) 60(45.5) Hepatic flexure 8(36.4) 33(25.0) Transverse colon 3(13.6) 23(17.4) Postoperative complications, n (%) 0.096 none 21(95.5) 130(98.5) anastomotic bleeding 0(0.0) 1(0.8) intestinal obstruction 1(4.5) 0(0.0) gastroparesis 0(0.0) 1(0.8) Continued BRAF status 0.005 Mut 5(22.7) 7(5.3) WT 17(77.3) 125(94.7) Vascular cancer embolus 0.526 Yes 6(27.3) 28(21.2) No 16(72.7) 104(78.8) Perineural invasion 0.115 Yes 7(31.8) 23(17.4) No 15(68.2) 109(82.6) Tumor deposits 0.031 Yes 6(27.3) 14(10.6) No 16(72.7) 118(89.4) T stage 0.108 I + II 1(4.5) 24(18.2) III + IV 21(95.5) 108(81.8) Poorly differentiated 0.015 Yes 10(45.5) 28(21.2) No 12(54.5) 104(78.8) pMMR 0.056 Yes 21(95.5) 103(78.0) No 1(4.5) 29(22.0) Tables 5. Univariate and multivariate analysis of risk factors for skipped lymph node metastasis Variable Univariate Multivariate OR 95%CI P value OR 95%CI P value Gender (Male) 3.200 1.179–8.689 0.022 2.542 0.854–7.570 0.094 Age 1.001 0.964–1.039 0.965 BMI 1.055 0.906–1.229 0.490 Hypertension 1.324 0.416–4.211 0.635 Diabetes 1.379 0.294–6.464 0.683 Coronary heart disease 0.656 0.070–6.16 0.712 T stage (I + II vs. III + IV) 4.667 0.598–36.405 0.142 Tumor location 0.973 0.594–1.594 0.914 Tumor size 1.038 0.851–1.268 0.711 Poorly differentiated 3.095 1.212–7.902 0.018 2.983 1.064–8.362 0.038 Pathological type 0.685 0.446–1.054 0.085 pMMR 5.913 0.763–45.835 0.089 8.177 0.925–72.304 0.059 BRAF V600E Mut 4.559 1.337–15.549 0.015 3.641 0.904–14.665 0.069 Vascular cancer embolus 1.393 0.499–3.889 0.527 Perineural invasion 2.212 0.811–6.033 0.121 Preoperative serum CEA ab 1.002 0.993–1.010 0.734 Preoperative serum CA19-9 ac 1.000 0.998–1.002 0.652 Tumor deposits 3.161 1.063–9.397 0.038 1.957 0.601–6.373 0.265 Univariate and Multivariate Logistic Regression Analyses of Risk Factors for Skipped Lymph Node Metastasis (SLNM) in Patients with Right-Sided Colon Cancer Table 4 presents a comparison of clinicopathological factors between patients with and without SLNM. The SLNM group had a significantly higher proportion of males (72.7% vs. 45.5%, P = 0.018) and a higher incidence of BRAF V600E mutation (22.7% vs. 5.3%, P = 0.005), tumor deposits (TD) (27.3% vs. 10.6%, P = 0.031), and poorly differentiated tumors (45.5% vs. 21.2%, P = 0.015) compared with the non-SLNM group. However, no significant differences were observed between the two groups in terms of age, BMI, tumor size, tumor location, preoperative serum carcinoembryonic antigen (CEA) level, vascular tumor emboli, perineural invasion, or T stage. ​ Univariate and multivariate logistic regression analyses (Table 5) identified significant risk factors for SLNM, including male gender (odds ratio [OR] = 3.200, 95% confidence interval [CI] = 1.179–8.689, P = 0.022), poorly differentiated pathology (OR = 3.095, 95% CI = 1.212–7.902, P = 0.018), and TD (OR = 3.161, 95% CI = 1.063–9.397, P = 0.038). Furthermore, multivariate analysis confirmed that poorly differentiated pathological grade was an independent high-risk factor for SLNM (OR = 2.983, 95% CI = 1.064–8.362, P = 0.038). Tumor deposits Tumor deposits (TD) are well recognized as a poor prognostic marker in colorectal cancer 14 – 17 . In the current study, TD was detected in 20 patients (12.99%). Notably, the proportion of female patients in the TD group was significantly higher than that in the non-TD group (80.0% vs. 44.8%, P = 0.007), as detailed in Table 6 . Further analysis revealed that compared with non-TD patients, patients with TD had a significantly lower rate of radical resection (65.0% vs. 97.8%, P < 0.001), greater intraoperative blood loss (mean [SD], 114.00 [237.52] vs. 53.13 [49.91] ml, P = 0.009), and a higher risk of perineural invasion (55.0% vs. 14.2%, P < 0.001). Additionally, patients with TD exhibited significantly elevated preoperative serum levels of carcinoembryonic antigen (CEA) (mean [SD], 79.18 [195.60] vs. 8.81 [19.88] ng/ml, P < 0.001) and carbohydrate antigen 19 − 9 (CA19-9) (mean [SD], 166.44 [475.05] vs. 34.24 [64.43] U/ml, P = 0.003). Univariate and multivariate logistic regression analyses identified several significant risk factors for TD occurrence, including female gender (OR [95% CI], 4.993 [1.556–15.339], P = 0.006), vascular tumor emboli (OR [95% CI], 2.760 [1.027–7.446], P = 0.044), perineural invasion (OR [95% CI], 7.398 [2.706–20.226], P < 0.001), and skipped lymph node metastasis (SLNM) (OR [95% CI], 3.161 [1.063–9.397], P = 0.038). Further multivariate analysis confirmed that female gender (OR [95% CI], 8.362 [1.587–44.069], P = 0.012) and perineural invasion (OR [95% CI], 10.824 [2.153–54.424], P = 0.004) were independent high-risk factors for TD, as corroborated by the data in Table 7 . Table 6. Clinicopathological features of TD and non-TD patients Characteristics TD(n = 20) non-TD(n = 134) P value Gender, n(%) 0.007 Male 4 (20.0) 74 (55.2) Female 16 (80.0) 60 (44.8) Age, (y, mean ± SD) 58.70 ± 14.29 56.97 ± 11.67 0.549 BMI, (y, mean ± SD) 22.66 ± 3.24 22.96 ± 3.00 0.686 Hypertension, n(%) 0.961 Yes 5 (25.0) 29 (21.6) No 15 (75.0) 105 (78.4) Diabetes, n(%) 0.532 Yes 1 (5.0) 17 (12.7) No 19 (95.0) 117 (87.3) Coronary heart disease, n(%) 1 Yes 1 (5.0) 4 (3.0) No 19 (95.0) 130 (97.0) Approach of surgery, n(% 0.238 Laparoscope 12 (60.0) 101 (75.4) Open 8 (40.0) 33 (24.6) Surgical type, n(% < 0.001 R0 13 (65.0) 131 (97.8) R1 7 (35.0) 1 (0.7) R2 0 (0.0) 2 (1.5) Tumor location, n(% 0.623 Ileocecum 4 (20.0) 15 (11.2) Ascending colon 9 (45.0) 59 (44.0) Hepatic flexure 5 (25.0) 36 (26.9) Transverse colon 2 (10.0) 24 (17.9) Postoperative complications, n (%) 0.928 none 20 (100.0) 131 (97.8) anastomotic bleeding 0 (0.0) 1 (0.7) intestinal obstruction 0 (0.0) 1 (0.7) gastroparesis 0 (0.0) 1 (0.7) Tumor size, (cm, mean ± SD) 5.20 ± 1.20 5.17 ± 2.46 0.951 Intraoperative blood loss , (ml, mean ± SD) 114.00 ± 237.52 53.13 ± 49.91 0.009 BRAF status 1 Mut 2 (10.0) 10 (7.5) WT 18 (90.0) 124 (92.5) Vascular cancer embolus 0.075 Yes 8 (40.0) 26 (19.4) No 12 (60.0) 108 (80.6) Continued Perineural invasion < 0.001 Yes 11 (55.0) 19 (14.2) No 9 (45.0) 115 (85.8) Preoperative serum CEA ab (mean ± SD) 79.18 ± 195.60 8.81 ± 19.88 < 0.001 Preoperative serum CA19-9 ac (mean ± SD) 166.44 ± 475.05 34.24 ± 64.43 0.003 SLNM (%) 0.07 Yes 6 (30.0) 16 (11.9) No 14 (70.0) 118 (88.1) T stage 0.256 I + II 1 (5.0) 24 (17.9) III + IV 19 (95.0) 110 (82.1) Poorly differentiated 0.384 Yes 7 (35.0) 31 (23.1) No 13 (65.0) 103 (76.9) pMMR 0.147 Yes 19 (95.0) 105 (78.4) No 1 (5.0) 29 (21.6) Tables 7. Univariate and multivariate analysis of risk factors for Tumor deposits Variable Univariate Multivariate OR 95%CI P value OR 95%CI P value Gender (Female) 4.933 1.556–15.539 0.006 8.362 1.587–44.069 0.012 Age 0.988 0.949–1.028 0.547 BMI 1.033 0.883–1.209 0.684 Hypertension 1.207 0.405–3.598 0.736 Diabetes 0.362 0.046–2.883 0.337 Coronary heart disease 1.711 0.181–16.125 0.639 T stage (I + II vs. III + IV) 0.241 0.031–1.890 0.176 Tumor location 1.392 0.812–2.387 0.230 Tumor size 0.994 0.813–1.215 0.951 Poorly differentiated 1.789 0.656–4.877 0.256 Pathological type 0.715 0.457–1.117 0.141 pMMR 5.248 0.674–40.864 0.113 BRAF V600E Mut 1.242 0.254–6.067 0.788 Vascular cancer embolus 2.769 1.027–7.466 0.044 1.269 0.262–6.149 0.767 Perineural invasion 7.398 2.706–20.226 < 0.001 10.824 2.153–54.424 0.004 Preoperative serum CEA ab 0.985 0.969–1.001 0.067 Preoperative serum CA19-9 ac 0.996 0.992–1.001 0.113 Skipped LN 3.161 1.063–9.397 0.038 Discussion Collectively, the results of this study underscore the necessity of CME combined with CVL for patients with right-sided colon cancer. We confirmed the safety of extended lymph node dissection (ELND) by observing rapid postoperative recovery in patients, despite the occurrence of three cases of postoperative complications. Given the intricate anatomical nature of GCLN dissection, its clinical application requires careful evaluation. Patients with early-stage colon cancer typically have a high cure rate following radical surgical resection. Lymph node dissection not only enhances the thoroughness of surgery but also reduces the risk of cancer recurrence and distant metastasis. Moreover, it provides crucial data for determining the indication of adjuvant chemotherapy and predicting patient survival 2 , 3 . As a common practice in radical resection of right-sided colon cancer, extended regional lymph node dissection has been extensively explored in clinical studies 10 , 13 , 18 , 19 . Although substantial attention has been focused on dissection of the L3 lymph node group, our study showed that the overall metastasis rate of the L3 group was 15.59%, with notable occurrences in advanced-stage patients. The survival advantage of D3 lymph node dissection over D2 dissection was evident in patients with T3-4 stage colon cancer. In our study, the primary metastasis pathways of ileocecal tumors were lymph node groups 201, 202, and 203. Tumors of the ascending colon exhibited extensive metastasis to both proximal and distal lymph nodes, which may be attributed to the absence of right colonic vessels. We observed a common trend of L3 lymph node metastasis in tumors of the colonic hepatic flexure, which is consistent with the findings reported by Hasegawa et al 20 . The metastasis pattern of transverse colon tumors was predominantly concentrated in groups 221, 222, and 223, suggesting an association with the right branch of the middle colic artery. The findings of Park et al. regarding lymph node metastasis in ileocecal and ascending colon cancer are consistent with our data 21 . However, our study suggests that the routine dissection of GCLN in right-sided colon cancer should be reevaluated, as it imposes additional surgical risks and our findings showed a lower-than-expected GCLN metastasis rate 6 , 11 . We also investigated the risk factors associated with SLNM and TD, and found that poorly differentiated tumors significantly increased the risk of SLNM. This indicates that extended lymph node dissection may be necessary for such cases 22 . The association between TD and poor prognosis highlights the importance of prudent surgical decision-making, particularly in female patients and those with perineural invasion 14 – 17 , 23 . Our ongoing long-term follow-up study aims to provide more valuable insights for clinical treatment. Our findings challenge the conventional approach of preserving the ileocecal valve in surgeries for hepatic flexure and transverse colon cancers located more than 10 cm from the ileocecal region 1 , 24 – 28 . The observed lymph node metastasis cases suggest potential risks associated with retaining the ileocecal region during right hemicolectomy. A deeper understanding of lymph node metastasis patterns and individualized surgical planning based on these patterns may improve patient outcomes while avoiding residual lesions. Limitations This study had several limitations. First, it was a single-center observational study conducted in a teaching hospital, leading to a potential selection bias toward patients with more advanced disease, such as lymph node or distant metastasis. Notably, most patients who had received neoadjuvant chemotherapy were excluded from this study, resulting in a smaller-than-expected sample size that requires further expansion in future studies. Additionally, long-term follow-up data are needed to evaluate long-term complications, quality of life, recurrence, and survival outcomes. Nevertheless, all data required for this study were prospectively collected without missing values, ensuring the reliability of the analysis. Conclusions This study highlights the necessity of complete mesocolic excision (CME) combined with central vascular ligation (CVL) for patients with right-sided colon cancer, underscoring its favorable safety profile. However, routine dissection of gastrocolic ligament lymph nodes (GCLN) is not routinely indicated in all cases. The analysis identifies poorly differentiated tumors as significant high-risk factors for skipped lymph node metastasis (SLNM). Additionally, female patients and those with perineural invasion are at an increased risk of developing tumor deposits (TD). This research emphasizes the need for further survival analysis to verify the long-term benefits of combining CME, CVL, and GCLN dissection in the treatment of right-sided colon cancer. Declarations Disclosure There is no conflict of interest among the authors in this study. Authors’ contributions L.Y., J.H.P., Z.Z.P., and J.Z.L. conceived and designed the project. L.Y., B.L., and Y.X.D. collected the data. J.B.Z., W.H.L., B.Y.X., Y.L., W.H.F., W.H.Z., X.J.W., Z.H.L. and L.R.L. analyzed and interpreted the data. L.Y. and J.H.P. drafted the manuscript. All authors read and approved the final manuscript. Funding This work was supported by the Bethune-Ethicon Excellence Surgery Fund [to J.Z.L.]. This work was supported by the grants from National Natural Science Foundation of China [82203461 to B.L.]. Guangzhou Science and Technology Project [202201011314 to B.L.]. Guangdong Medical Science and Technology Research Foundation [2019111811570248 to B.L.]. Ethics approval and consent to participate This prospective observational study involving human participants was conducted in strict accordance with the principles of the Declaration of Helsinki (https://www.wma.net/policies-post/wma-declaration-of-helsinki/). The study protocol was reviewed and approved by the Ethics Committee of Sun Yat-Sen University Cancer Center (Approval No.: B2019-071-07). All participants (or their legally authorized representatives) were fully informed of the study objectives, procedures, potential risks, and benefits prior to enrollment. Written informed consent was obtained from each participant before any study-related procedures were performed. Consent for publication Not Applicable . This manuscript does not contain any individual person’s identifiable images or clinical details that could compromise participant anonymity. Data availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to privacy and ethical restrictions related to patient clinical information. References SungH,FerlayJ,SiegelRL,etal.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.Cancer J Clin.2021;71(3):209–249.doi:10.3322/caac.21660. AkagiY,AdachiY,KinugasaT,OkaY,MizobeT,ShirouzuK.LymphNodeEvaluationandSurvivalinColorectalCancer:ReviewofPopulation-based,ProspectiveStudies. ANTICANCER RESEARCH .Publishedonline2013:9. JinM,FrankelWL.Lymph Node Metastasis in Colorectal Cancer.Surg Oncol Clin N Am.2018;27(2):401–412.doi:10.1016/j.soc.2017.11.011. JamiesonJK,DobsonJF.THE LYMPHATICS OFTHE COLON. WITH SPECIAL REFERENCE TO THE OPERATIVE TREATMENT OF CANCER OF THE COLON:Ann Surg.1909;50(6):1077–1090.doi:10.1097/00000658-190912000-00007. ToyotaS,OhtaH,AnazawaS.Rationale for extent of lymph node dissection for right colon cancer.Dis Colon Rectum.1995;38(7):705–711.doi:10.1007/bf02048026. BertelsenCA,BolsB,IngeholmP,etal.Lymph Node Metastases in the Gastrocolic Ligament in Patients With Colon Cancer.Dis Colon Rectum.2014;57(7):839–845.doi:10.1097/dcr.0000000000000144. HohenbergerW,WeberK,MatzelK,PapadopoulosT,MerkelS.Standardized surgery for colonic cancer: complete mesocolic excision and central ligation - technical notes and outcome.Colorectal Dis.2009;11(4):354–364.doi:10.1111/j.1463-1318.2008.01735.x. UematsuD,AkiyamaG,SugiharaT,MagishiA,YamaguchiT,SanoT.Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure: Lymph node dissection for colon cancer.Asian J Endosc Surg.2017;10(1):23–27.doi:10.1111/ases.12311. LeeSD,LimSB.D3 lymphadenectomy using a medial to lateral approach for curable right-sided colon cancer.Int J Colorectal Dis.2009;24(3):295–300.doi:10.1007/s00384-008-0597-7. LiangJT,LaiHS,HuangJ,SunCT.Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes.Surg Endosc.2015;29(8):2394–2401.doi:10.1007/s00464-014-3940-9. SunY,ZhangD,FengY,etal.Infrapyloric lymph node dissection in right hemicolectomy for colon cancer: Should prophylactic resection be recommended?J Surg Oncol.2021;123(S1).doi:10.1002/jso.26388. BauerKM,HummonAB,BuechlerS.Right-side and left-side colon cancer follow different pathways to relapse: RELAPSE IN RIGHT-SIDE AND LEFT-SIDE COLON CANCER.Mol Carcinog.2012;51(5):411–421.doi:10.1002/mc.20804. KataokaK,BeppuN,ShiozawaM,etal.Colorectal cancer treated by resection and extended lymphadenectomy: patterns of spread in left- and right-sided tumours.Br J Surg.2020;107(8):1070–1078.doi:10.1002/bjs.11517. BasnetS,LouQfeng,LiuN,etal.Tumor deposit is an independent prognostic indicator in patients who underwent radical resection for colorectal cancer.J Cancer.2018;9(21):3979–3985.doi:10.7150/jca.27475. BeltEJTh,vanStijnMFM,BrilH,etal.Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III.Ann Surg Oncol.2010;17(12):3203–3211.doi:10.1245/s10434-010-1152-7. PuppaG,UenoH,KayaharaM,etal.Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases.Mod Pathol.2009;22(3):410–415.doi:10.1038/modpathol.2008.198. ShiM,ZhangH,YaoG,etal.The Role of Tumor Deposits in Predicting the Efficacy of Chemotherapy in Stage III Colon Cancer.Front Oncol.2020;10:586603.doi:10.3389/fonc.2020.586603. PaquetteIM,MadoffRD,SigurdsonER,ChangGJ.Impact of Proximal Vascular Ligation on Survival of Patients with Colon Cancer.Ann Surg Oncol.2018;25(1):38–45.doi:10.1245/s10434-016-5720-3. KanemitsuY,KomoriK,KimuraK,KatoT.D3 Lymph Node Dissection in Right Hemicolectomy with a No-touch Isolation Technique in Patients With Colon Cancer.Dis Colon Rectum.2013;56(7):815–824.doi:10.1097/dcr.0b013e3182919093. HasegawaS,KawamuraJ,NagayamaS,NomuraA,KondoK,SakaiY.Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers.Surg Endosc.2007;21(9):1657–1657.doi:10.1007/s00464-007-9305-x. ParkIJ,ChoiGS,KangBM,LimKH,JunSH.Lymph Node Metastasis Patterns in Right-Sided Colon Cancers: Is Segmental Resection of These Tumors Oncologically Safe?Ann Surg Oncol.2009;16(6):1501–1506.doi:10.1245/s10434-009-0368-x. CUIYcheng,GAO Zdong,HAN L.High risk factors of lymphatic metastasis pattern of right colon neoplasms: a single-center prospective observational study.Chin J Practical Surg.2015;35(06):659–663. LiuF,ZhaoJ,LiC,etal.The unique prognostic characteristics of tumor deposits in colorectal cancer patients.Ann Transl Med.2019;7(23):769–769.doi:10.21037/atm.2019.11.69. KangSI,KimDW,ShinE,etal.Clinical Significance of Lymph Node Metastasis in the Mesentery of the Terminal Ileum in Patients With Right-sided Colon Tumors at Different Locations.Dis Colon Rectum.2018;61(6):692–697.doi:10.1097/dcr.0000000000001048. EfetovSK,ZubayraevaAA,NekovalVM,TyanAS,TulinaIA,TsarkovPV.Extended Colectomy Followed by Cecorectal Anastomosis as a Surgical Treatment Modality in Synchronous Colorectal Cancer.Case Rep Oncol.2020;13(2):813–821.doi:10.1159/000508266. FernandoEDPS,DeenKI.Consideration of the blood supply of the ileocecal segment in valve preserving right hemicolectomy.Clin Anat.2009;22(6):712–715.doi:10.1002/ca.20838. SuH,WuH,MuB,etal.The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer.World J Surg Onc.2020;18(1):159.doi:10.1186/s12957-020-01922-8. PratapA,FlemingJB,BarnettCC.Right hemicolectomy using ileocecal pedicel flap—a new technique for ileocecal sphincter preservation in complex Crohn’s disease with right sided colon cancer.Int J Colorectal Dis.2016;31(9):1669–1670.doi:10.1007/s00384-016-2601-y. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8593596","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593246012,"identity":"504059ce-6543-42e9-ab3c-659416c9c81c","order_by":0,"name":"Long Yu","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Long","middleName":"","lastName":"Yu","suffix":""},{"id":593246013,"identity":"4c9211cc-c7af-4020-81f1-6cbb3bca28ff","order_by":1,"name":"Yuxiang Deng","email":"","orcid":"","institution":"Peking University Shenzhen 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Center","correspondingAuthor":false,"prefix":"","firstName":"Jianhong","middleName":"","lastName":"Peng","suffix":""},{"id":593246027,"identity":"26b896fc-6a5b-4bb8-be06-54c73a4e8bc3","order_by":15,"name":"Junzhong Lin","email":"","orcid":"","institution":"Sun Yat-sen University Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Junzhong","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2026-01-13 15:09:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8593596/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8593596/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103177921,"identity":"09e8c2ed-401e-448f-a493-01f7f01a7060","added_by":"auto","created_at":"2026-02-22 16:56:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":175318,"visible":true,"origin":"","legend":"\u003cp\u003eThe absolute rate of lymph node metastasis at each station\u003cstrong\u003e. \u003c/strong\u003eThe size of the graph represents the proportion of lymph node metastasis, and different colors represent lymph nodes in different locations.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8593596/v1/d43397721cba88a15bc04b52.png"},{"id":104405202,"identity":"e95994b1-1ca5-40dd-9a0f-6cc2db464715","added_by":"auto","created_at":"2026-03-11 12:22:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1821587,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8593596/v1/3775c4c3-32ad-4161-ad94-882c81b287af.pdf"},{"id":103177920,"identity":"bc8d08cc-768a-4e3f-8bd5-4aba00a23778","added_by":"auto","created_at":"2026-02-22 16:56:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":4002738,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigure1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8593596/v1/ed7c9fe524fef07714901c90.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of the Necessity of Gastrocolic Ligament Lymph Node Dissection and Related Risk Factors in Right Hemicolectomy for Colon Cancer: A Prospective Observational Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incidence and mortality of colorectal cancer (CRC) have continued to rise in recent years. Currently, colon cancer accounts for more than 50% of newly diagnosed CRC cases\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In 2020, it was estimated that CRC would result in over 1.90\u0026nbsp;million new cases and 935,000 deaths worldwide. Given these compelling statistics, understanding and optimizing treatment strategies are of utmost importance. Surgery remains the primary therapeutic modality for advanced colon cancer, and lymph node dissection serves as a critical component of radical resection. The depth of tumor invasion and the extent of lymph node metastasis are key determinants for guiding adjuvant chemotherapy decisions and predicting prognosis in patients with CRC\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe right colon, characterized by more extensive lymphatic drainage pathways, confers a higher risk of lymph node metastasis compared with the left colon. Metastatic spread in right colon cancer primarily follows two pathways: either merging with lymphatic reflux from the stomach and pancreas before draining into the superior mesenteric vein (SMV), or redirecting leftward to converge into the SMV\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The gastrocolic ligament lymph node (GCLN) is a well-recognized potential metastatic site in right colon cancer. However, the clinical benefits of extended lymph node dissection (ELND) remain controversial due to the paucity of high-quality clinical evidence\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRecent studies have centered on the safety and clinical significance of complete mesocolic excision (CME) combined with central vascular ligation (CVL) and D3 lymph node dissection in patients with right-sided colon cancer\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Despite these advances, there is a scarcity of prospective, large-scale studies investigating the pattern of lymph node metastasis and the necessity of ELND in this patient population. The present study aims to address this research gap by prospectively collecting data from patients with right-sided colon cancer who undergo CME combined with CVL and GCLN dissection. Specifically, we aim to quantify the incidence of GCLN metastasis and assess the optimal extent of lymph node dissection required for right-sided colon cancer surgery. Additionally, we will analyze the correlations among skipped lymph node metastasis (SLNM), tumor deposits (TD), tumor location, and other clinicopathological risk factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Enrollment\u003c/h2\u003e \u003cp\u003eThis was a prospective observational study involving consecutive adult patients (aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years) diagnosed with right-sided colon cancer who underwent CME\u0026thinsp;+\u0026thinsp;CVL\u0026thinsp;+\u0026thinsp;GCLN dissection at our hospital between October 24, 2019, and December 26, 2021. All patients diagnosed with right-sided colon cancer who participated in this prospective observational study provided written informed consent prior to enrollment. The informed consent process was conducted in accordance with the ethical guidelines approved by the institutional review board, and all participants were fully informed of the study purpose, procedures, potential risks, and benefits. Ethical approval was obtained from the Ethics Committee of Sun Yat-Sen University Cancer Center \u003cb\u003e(Approval No.: B2019-071-07)\u003c/b\u003e, and the study was registered in the Chinese Clinical Trial Registry \u003cb\u003e(ChiCTR;\u003c/b\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.chictr.org.cn\u003c/span\u003e\u003cspan address=\"http://www.chictr.org.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; \u003cb\u003eRegistration No.: ChiCTR2100042014; Clinical Trial Registration Date: 2019-1-1)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003ePreoperative diagnosis of right-sided colon cancer was confirmed by endoscopic biopsy, followed by CME\u0026thinsp;+\u0026thinsp;CVL\u0026thinsp;+\u0026thinsp;GCLN dissection. Patients were eligible for enrollment if they met the following preoperative criteria: (1) aged 18 years or older; (2) tumor foci located in the ileocecal junction, ascending colon, hepatic flexure of the colon, or right transverse colon; (3) Eastern Cooperative Oncology Group (ECOG) performance status score\u0026thinsp;\u0026le;\u0026thinsp;2; (4) good compliance and voluntary acceptance of follow-up, laboratory tests, and other study protocols.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were: (1) prior receipt of neoadjuvant therapy (radiotherapy or chemotherapy); (2) diagnosis of a second primary malignancy within the past 5 years; (3) participation in other clinical trials during the planned study period; (4) pregnancy and/or lactation; (5) life expectancy\u0026thinsp;\u0026le;\u0026thinsp;30 days as documented in the patient\u0026rsquo;s medical record by the attending clinician.\u003c/p\u003e \u003cp\u003eIn the present study, the criteria for anatomical lymph node stations established by the Japanese Society for Cancer of the Colon and Rectum were adopted for defining the locations of lymph nodes \u003cb\u003e(Supplementary Fig.\u0026nbsp;1)\u003c/b\u003e. The postoperative clinicopathological parameters of each patient encompassed the depth of tumor invasion, the number of metastatic lymph nodes, vascular tumor emboli, perineural invasion, tumor deposits (TD), tumor differentiation grade, and lymph node groups 201, 202, 203, 204, 206, 211, 212, 213, 221, 222, and 223.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePrimary and secondary endpoints.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe primary endpoint of this study was defined as the lymph node metastasis rate in the gastrocolic ligament. The secondary endpoints were the identification of risk factors associated with skipped lymph node metastasis (SLNM) and tumor deposits (TD).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical procedures\u003c/h3\u003e\n\u003cp\u003eAll surgical procedures were performed by experienced colorectal surgeons, and postoperative lymph node dissection was conducted by trained residents and postgraduates. Complete mesocolic excision (CME) was performed using an inside-to-outside approach11. Following thorough abdominal exploration, the transverse colon was retracted ventrally, and the small intestine was positioned to the left. The colonic mesentery was incised on the caudal side of the ileocolic vessels. Central lymph node dissection was performed along the left side of the superior mesenteric artery (SMA). The mesenteric adipose tissue containing lymph nodes was meticulously dissected layer by layer using an ultrasonic scalpel. The origins of the ileocolic vessels, right colic artery (if present), and middle colic vessels or their right-sided branches were ligated.\u003c/p\u003e \u003cp\u003eThe Toldt's space was completely dissected, and the right colonic mesentery was fully separated from the retroperitoneal tissue, pancreatic head, and duodenum. The gastrocolic trunk was exposed using the right gastroepiploic vein (RGEV), right colic vein (RCV), and anterior superior pancreaticoduodenal vein (ASPDV) as landmarks. The RCV and ASPDV were anastomosed, while the RGEV was preserved. Subsequently, the greater omentum was detached from the gastroepiploic vessels to open the lesser sac. The transverse mesocolon was dissected, and communication was established through the mesenteric opening of the transverse mesocolon to the posterior anatomical space. This dissection was extended to the right by fusing the transverse mesocolon with the duodenal mesentery.\u003c/p\u003e \u003cp\u003eAdipose tissue containing lymph nodes below the pylorus was harvested from the right gastric vascular bundle via the duodenum. After mobilization of the right colon, extracorporeal colectomy and end-to-end anastomosis were performed.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe following clinical and pathological data were collected for study analysis: gender, age, body mass index (BMI), comorbidities (including hypertension, diabetes mellitus, or coronary heart disease), tumor location, preoperative serum tumor markers, intraoperative blood loss, operation duration, length of hospital stay, postoperative pathological stage, postoperative complications, and other relevant clinical and pathological data. All patients were staged in accordance with the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eIn this study, continuous data were described as mean (standard deviation [SD]), and categorical (nominal) data were presented as counts and percentages. For intergroup comparisons, the Wilcoxon rank-sum test was used for continuous variables, while the χ\u0026sup2; test or Fisher\u0026rsquo;s exact test was applied for categorical (nominal) variables as appropriate. Logistic regression models were utilized to identify risk factors for skipped lymph node metastasis (SLNM) and tumor deposits (TD), with odds ratios (OR) calculated to quantify the associations. All statistical analyses were performed using SPSS software (version 20.0), and data visualization was completed using GraphPad Prism software (version 8.0). A two-tailed P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics\u003c/h2\u003e \u003cp\u003eIn this study, 154 eligible patients with right-sided colon cancer who underwent complete mesocolic excision (CME) combined with central vascular ligation (CVL) and gastrocolic ligament lymph node (GCLN) dissection were analyzed. Among these patients, 78 were male (50.6%). Their ages ranged from 28 to 87 years, with a mean of 57.2 years (SD\u0026thinsp;=\u0026thinsp;12 years), and the body mass index (BMI) ranged from 15.6 to 32.1 kg/m\u0026sup2; (mean [SD], 22.9 [3] kg/m\u0026sup2;). Notably, 34 patients (21.9%) had hypertension, 18 (11.6%) had diabetes mellitus, and 5 (3.2%) had coronary heart disease.\u003c/p\u003e \u003cp\u003ePreoperative examinations showed normal levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (CA19-9), lymphocytes, neutrophils, monocytes, platelets, hemoglobin, and albumin, except for C-reactive protein levels which were abnormal in some cases. Regarding surgical approaches, 113 patients (73.4%) underwent laparoscopic surgery, while 41 (26.6%) underwent open surgery. R0 resection was achieved in 144 patients (93.5%), accounting for the majority. Tumor locations were distributed as follows: ileocecal junction (12.3%), ascending colon (44.2%), hepatic flexure (26.6%), and right transverse colon (16.9%). Only one case of massive intraoperative bleeding occurred, which was successfully managed. Postoperative complications were rare, occurring in 3 patients (1 case of anastomotic bleeding, 1 case of intestinal obstruction, and 1 case of gastroparesis). The mean postoperative recovery time was 3.2 days (SD\u0026thinsp;=\u0026thinsp;0.9 days; range, 1.0\u0026ndash;7.0 days).\u003c/p\u003e \u003cp\u003ePostoperative pathological examinations revealed a median of 37 retrieved lymph nodes (range, 8\u0026ndash;97) and a median of 1 metastatic lymph node (range, 1\u0026ndash;24). Notably, 45 patients (29.2%) had metastatic lymph nodes (note: original text \u0026ldquo;44.1%\u0026rdquo; was corrected based on 45/154\u0026thinsp;\u0026asymp;\u0026thinsp;29.2% to ensure data accuracy). Further details on patient characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline data and clinicopathological characteristics of patientswith right-side colon cancer(n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (y\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0 (28.0\u0026ndash;87.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (50.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (49.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD kg/m\u003csup\u003e2\u003c/sup\u003e) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 (15.6\u0026ndash;32.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (77.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (11.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (87.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCoronary heart disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (96.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative lymphocyte\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 (1.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative neutrophils\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 (2.0\u0026ndash;16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative monocyte\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 (0.0\u0026ndash;3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative platelet\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e314.8\u0026thinsp;\u0026plusmn;\u0026thinsp;104.8 (75.0-634.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative hemoglobin\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112.8\u0026thinsp;\u0026plusmn;\u0026thinsp;24.7 (56.0-164.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative albumin\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 (27.0\u0026ndash;50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative C-reactive protein\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;28.5 (0.0-283.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative serum CEA\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;75.2 (1.0-792.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative serum CA19-9\u003csup\u003eac\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.8\u0026thinsp;\u0026plusmn;\u0026thinsp;184.9 (1.0-2110.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocecum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e19(12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eascending colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e68(44.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehepatic flexure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e41(26.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etransverse colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e26(16.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical method, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e113(73.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eopen surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e41(26.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;97.0(10.0-1100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eContinued\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e17(11.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8(5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e103(66.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e26(16.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e92(59.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e39(25.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e23(14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15(9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e71(46.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e51(33.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e17(11.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLongest diameter of tumor (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3(1.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollected 204 group lymph node (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8(0\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollected 206 group lymph node (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2(0\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e151(98.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanastomotic bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eintestinal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egastroparesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative exhausting time (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9(1.0\u0026ndash;7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9(3.0\u0026ndash;22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003e Absolute value in blood, \u003csup\u003eb\u003c/sup\u003e CEA carcinoembryonic antigen, \u003csup\u003ec\u003c/sup\u003e CA19-9 carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMetastasis rate of each lymph node station\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the metastasis rates of paracolic lymph nodes (L1), particularly focusing on groups 201, 211, and 221. The absolute metastasis rates in these groups were 11.69% (18 patients), 12.34% (19 patients), and 8.44% (13 patients), respectively. Notably, the median number of retrieved gastrocolic ligament lymph nodes (GCLNs) was 1 (range, 1\u0026ndash;20). No lymph node metastasis was detected in group 204. Detailed absolute metastasis rates of each lymph node station are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAbsolute metastasis rate at each lymph node station\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRight colon cancer lymph node substation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of positive lymph nodes// / total\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eParacolic lymph nodes\u003c/p\u003e \u003cp\u003e(L1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e211 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e221 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.44%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIntermediate lymph nodes (L2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e212 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e222 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCentral lymph nodes\u003c/p\u003e \u003cp\u003e(L3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e213 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.55%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGastrocolic ligament lymph node (GCLN)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e204 group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA unique case in the 206 nodal group was a 57-year-old woman with stage IV right transverse colon cancer and liver metastases. Of the 59 lymph nodes retrieved, 24 were metastatic. Her primary tumor was classified as a poorly differentiated tubular adenocarcinoma and exhibited vascular tumor thrombosis, nerve bundle invasion, and tumor deposits. Postoperative pathology also revealed her mismatch repair (MMR) status as proficient (pMMR).\u003c/p\u003e\n\u003ch3\u003eSkipped lymph node metastasis (SLNM)\u003c/h3\u003e\n\u003cp\u003eOur study demonstrated that right-sided colon cancer is prone to skipped lymph node metastasis (SLNM)\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Among the 154 patients, 22 (14.28%) had SLNM. The distribution of SLNM by tumor location was as follows: 3 cases (1.95%) in the ileocecal junction, 8 cases (5.19%) in the ascending colon, 8 cases (5.19%) in the hepatic flexure, and 3 cases (1.95%) in the right transverse colon. Notably, tumors located in the ascending colon and hepatic flexure exhibited the highest SLNM rates, with metastasis primarily involving the L3 lymph node group. We classified the patterns of SLNM into four categories: L1-L2\u0026thinsp;+\u0026thinsp;L3+, L1-L2\u0026thinsp;+\u0026thinsp;L3-, L1-L2-L3+, and L1\u0026thinsp;+\u0026thinsp;L2-L3+ \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Consistent with the location distribution, tumors in the ascending colon and hepatic flexure had the highest SLNM rates, mainly invading the L3 group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between skipped lymph node metastasis and tumor location\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eL1- L2\u0026thinsp;+\u0026thinsp;L3+\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL1- L2\u0026thinsp;+\u0026thinsp;L3-\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eL1- L2- L3+\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eL1\u0026thinsp;+\u0026thinsp;L2- L3+\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocecum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eascending colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.19%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehepatic flexure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.19%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etransverse colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;4. Clinicopathological features of SLNM and non-SLNM patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSLNM(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-SLNM(n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, (y, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, (kg/m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size, (cm, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss\u003c/p\u003e \u003cp\u003e, (ml, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.3\u0026thinsp;\u0026plusmn;\u0026thinsp;103.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative serum CEA\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8\u0026thinsp;\u0026plusmn;\u0026thinsp;80.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative serum CA19-9\u003csup\u003eac\u003c/sup\u003e (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.6\u0026thinsp;\u0026plusmn;\u0026thinsp;124.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.9\u0026thinsp;\u0026plusmn;\u0026thinsp;193.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102(77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116(87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128(97.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproach of surgery, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical type, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124(93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocecum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscending colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatic flexure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransverse colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130(98.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanastomotic\u0026nbsp;bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eintestinal\u0026nbsp;obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egastroparesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContinued\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRAF status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125(94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular cancer embolus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104(78.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109(82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor deposits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118(89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u0026thinsp;+\u0026thinsp;II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u0026thinsp;+\u0026thinsp;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorly differentiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104(78.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epMMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103(78.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eTables\u0026nbsp;5. Univariate and multivariate analysis of risk factors for skipped lymph node metastasis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.179\u0026ndash;8.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.854\u0026ndash;7.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.964\u0026ndash;1.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.906\u0026ndash;1.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.416\u0026ndash;4.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.294\u0026ndash;6.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.070\u0026ndash;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage (I\u0026thinsp;+\u0026thinsp;II vs. III\u0026thinsp;+\u0026thinsp;IV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.598\u0026ndash;36.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.594\u0026ndash;1.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.851\u0026ndash;1.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorly differentiated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.212\u0026ndash;7.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.064\u0026ndash;8.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.446\u0026ndash;1.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epMMR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.763\u0026ndash;45.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.925\u0026ndash;72.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.059\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBRAF V600E Mut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.337\u0026ndash;15.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.904\u0026ndash;14.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.069\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular cancer embolus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.499\u0026ndash;3.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.811\u0026ndash;6.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative serum CEA\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.993\u0026ndash;1.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative serum CA19-9\u003csup\u003eac\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.998\u0026ndash;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor deposits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.063\u0026ndash;9.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.601\u0026ndash;6.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eUnivariate and Multivariate Logistic Regression Analyses of Risk Factors for Skipped Lymph Node Metastasis (SLNM) in Patients with Right-Sided Colon Cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;4\u003c/b\u003e presents a comparison of clinicopathological factors between patients with and without SLNM. The SLNM group had a significantly higher proportion of males (72.7% vs. 45.5%, P\u0026thinsp;=\u0026thinsp;0.018) and a higher incidence of BRAF V600E mutation (22.7% vs. 5.3%, P\u0026thinsp;=\u0026thinsp;0.005), tumor deposits (TD) (27.3% vs. 10.6%, P\u0026thinsp;=\u0026thinsp;0.031), and poorly differentiated tumors (45.5% vs. 21.2%, P\u0026thinsp;=\u0026thinsp;0.015) compared with the non-SLNM group. However, no significant differences were observed between the two groups in terms of age, BMI, tumor size, tumor location, preoperative serum carcinoembryonic antigen (CEA) level, vascular tumor emboli, perineural invasion, or T stage.\u003c/p\u003e \u003cp\u003e​ Univariate and multivariate logistic regression analyses \u003cb\u003e(Table\u0026nbsp;5)\u003c/b\u003e identified significant risk factors for SLNM, including male gender (odds ratio [OR]\u0026thinsp;=\u0026thinsp;3.200, 95% confidence interval [CI]\u0026thinsp;=\u0026thinsp;1.179\u0026ndash;8.689, P\u0026thinsp;=\u0026thinsp;0.022), poorly differentiated pathology (OR\u0026thinsp;=\u0026thinsp;3.095, 95% CI\u0026thinsp;=\u0026thinsp;1.212\u0026ndash;7.902, P\u0026thinsp;=\u0026thinsp;0.018), and TD (OR\u0026thinsp;=\u0026thinsp;3.161, 95% CI\u0026thinsp;=\u0026thinsp;1.063\u0026ndash;9.397, P\u0026thinsp;=\u0026thinsp;0.038). Furthermore, multivariate analysis confirmed that poorly differentiated pathological grade was an independent high-risk factor for SLNM (OR\u0026thinsp;=\u0026thinsp;2.983, 95% CI\u0026thinsp;=\u0026thinsp;1.064\u0026ndash;8.362, P\u0026thinsp;=\u0026thinsp;0.038).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTumor deposits\u003c/h2\u003e \u003cp\u003eTumor deposits (TD) are well recognized as a poor prognostic marker in colorectal cancer\u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. In the current study, TD was detected in 20 patients (12.99%). Notably, the proportion of female patients in the TD group was significantly higher than that in the non-TD group (80.0% vs. 44.8%, P\u0026thinsp;=\u0026thinsp;0.007), as detailed in \u003cb\u003eTable\u0026nbsp;6\u003c/b\u003e. Further analysis revealed that compared with non-TD patients, patients with TD had a significantly lower rate of radical resection (65.0% vs. 97.8%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), greater intraoperative blood loss (mean [SD], 114.00 [237.52] vs. 53.13 [49.91] ml, P\u0026thinsp;=\u0026thinsp;0.009), and a higher risk of perineural invasion (55.0% vs. 14.2%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, patients with TD exhibited significantly elevated preoperative serum levels of carcinoembryonic antigen (CEA) (mean [SD], 79.18 [195.60] vs. 8.81 [19.88] ng/ml, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (CA19-9) (mean [SD], 166.44 [475.05] vs. 34.24 [64.43] U/ml, P\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003eUnivariate and multivariate logistic regression analyses identified several significant risk factors for TD occurrence, including female gender (OR [95% CI], 4.993 [1.556\u0026ndash;15.339], P\u0026thinsp;=\u0026thinsp;0.006), vascular tumor emboli (OR [95% CI], 2.760 [1.027\u0026ndash;7.446], P\u0026thinsp;=\u0026thinsp;0.044), perineural invasion (OR [95% CI], 7.398 [2.706\u0026ndash;20.226], P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and skipped lymph node metastasis (SLNM) (OR [95% CI], 3.161 [1.063\u0026ndash;9.397], P\u0026thinsp;=\u0026thinsp;0.038). Further multivariate analysis confirmed that female gender (OR [95% CI], 8.362 [1.587\u0026ndash;44.069], P\u0026thinsp;=\u0026thinsp;0.012) and perineural invasion (OR [95% CI], 10.824 [2.153\u0026ndash;54.424], P\u0026thinsp;=\u0026thinsp;0.004) were independent high-risk factors for TD, as corroborated by the data in \u003cb\u003eTable\u0026nbsp;7\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTable\u0026nbsp;6. Clinicopathological features of TD and non-TD patients\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCharacteristics\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTD(n\u0026thinsp;=\u0026thinsp;20)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003enon-TD(n\u0026thinsp;=\u0026thinsp;134)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eP\u003c/span\u003e value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender, n(%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.007\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (20.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e74 (55.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e16 (80.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e60 (44.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge, (y, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e58.70\u0026thinsp;\u0026plusmn;\u0026thinsp;14.29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e56.97\u0026thinsp;\u0026plusmn;\u0026thinsp;11.67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.549\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI, (y, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.686\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypertension, n(%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.961\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (25.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e29 (21.6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e15 (75.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e105 (78.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDiabetes, n(%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.532\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (5.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e17 (12.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (95.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e117 (87.3)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCoronary heart disease, n(%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (5.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (3.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (95.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e130 (97.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eApproach of surgery, n(%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.238\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLaparoscope\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e12 (60.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e101 (75.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOpen\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (40.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e33 (24.6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical type, n(%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eR0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e13 (65.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e131 (97.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eR1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (35.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (0.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eR2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (1.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTumor location, n(%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.623\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIleocecum\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (20.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e15 (11.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAscending colon\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9 (45.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e59 (44.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHepatic flexure\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (25.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e36 (26.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTransverse colon\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (10.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24 (17.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePostoperative complications, n (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.928\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003enone\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e20 (100.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e131 (97.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eanastomotic\u0026nbsp;bleeding\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (0.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eintestinal\u0026nbsp;obstruction\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (0.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003egastroparesis\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (0.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTumor size, (cm, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.951\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIntraoperative blood loss\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e, (ml, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e114.00\u0026thinsp;\u0026plusmn;\u0026thinsp;237.52\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e53.13\u0026thinsp;\u0026plusmn;\u0026thinsp;49.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.009\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBRAF status\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMut\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (10.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10 (7.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWT\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18 (90.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e124 (92.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVascular cancer embolus\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.075\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (40.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e26 (19.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e12 (60.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e108 (80.6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eContinued\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePerineural invasion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11 (55.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (14.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9 (45.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e115 (85.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreoperative serum CEA\u003csup\u003eab\u003c/sup\u003e\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e79.18\u0026thinsp;\u0026plusmn;\u0026thinsp;195.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.81\u0026thinsp;\u0026plusmn;\u0026thinsp;19.88\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreoperative serum CA19-9\u003csup\u003eac\u003c/sup\u003e (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e166.44\u0026thinsp;\u0026plusmn;\u0026thinsp;475.05\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e34.24\u0026thinsp;\u0026plusmn;\u0026thinsp;64.43\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.003\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSLNM (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.07\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 (30.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e16 (11.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 (70.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e118 (88.1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eT stage\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.256\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u0026thinsp;+\u0026thinsp;II\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (5.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24 (17.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u0026thinsp;+\u0026thinsp;IV\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (95.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e110 (82.1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePoorly differentiated\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.384\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (35.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e31 (23.1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e13 (65.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e103 (76.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003epMMR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.147\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (95.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e105 (78.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (5.0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e29 (21.6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTables\u0026nbsp;7. Univariate and multivariate analysis of risk factors for Tumor deposits\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnivariate\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eMultivariate\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eOR\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e95%CI\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eP value\u003c/span\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eOR\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e95%CI\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eP value\u003c/span\u003e\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender (Female)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.933\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.556\u0026ndash;15.539\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.006\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.362\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.587\u0026ndash;44.069\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.012\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.988\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.949\u0026ndash;1.028\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.547\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.033\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.883\u0026ndash;1.209\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.684\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHypertension\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.207\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.405\u0026ndash;3.598\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.736\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDiabetes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.362\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.046\u0026ndash;2.883\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.337\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCoronary heart disease\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.711\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.181\u0026ndash;16.125\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.639\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eT stage (I\u0026thinsp;+\u0026thinsp;II vs. III\u0026thinsp;+\u0026thinsp;IV)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.241\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.031\u0026ndash;1.890\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.176\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTumor location\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.392\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.812\u0026ndash;2.387\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.230\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTumor size\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.994\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.813\u0026ndash;1.215\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.951\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePoorly differentiated\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.789\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.656\u0026ndash;4.877\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.256\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePathological type\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.715\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.457\u0026ndash;1.117\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.141\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003epMMR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.248\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.674\u0026ndash;40.864\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.113\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBRAF V600E Mut\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.242\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.254\u0026ndash;6.067\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.788\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVascular cancer embolus\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.769\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.027\u0026ndash;7.466\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.044\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.269\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.262\u0026ndash;6.149\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.767\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePerineural invasion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.398\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.706\u0026ndash;20.226\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.824\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.153\u0026ndash;54.424\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.004\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreoperative serum CEA\u003csup\u003eab\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.985\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.969\u0026ndash;1.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.067\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreoperative serum CA19-9\u003csup\u003eac\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.996\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.992\u0026ndash;1.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.113\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSkipped LN\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.161\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.063\u0026ndash;9.397\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e0.038\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Discussion","content":"\u003cp\u003eCollectively, the results of this study underscore the necessity of CME combined with CVL for patients with right-sided colon cancer. We confirmed the safety of extended lymph node dissection (ELND) by observing rapid postoperative recovery in patients, despite the occurrence of three cases of postoperative complications. Given the intricate anatomical nature of GCLN dissection, its clinical application requires careful evaluation.\u003c/p\u003e \u003cp\u003ePatients with early-stage colon cancer typically have a high cure rate following radical surgical resection. Lymph node dissection not only enhances the thoroughness of surgery but also reduces the risk of cancer recurrence and distant metastasis. Moreover, it provides crucial data for determining the indication of adjuvant chemotherapy and predicting patient survival\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. As a common practice in radical resection of right-sided colon cancer, extended regional lymph node dissection has been extensively explored in clinical studies\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Although substantial attention has been focused on dissection of the L3 lymph node group, our study showed that the overall metastasis rate of the L3 group was 15.59%, with notable occurrences in advanced-stage patients. The survival advantage of D3 lymph node dissection over D2 dissection was evident in patients with T3-4 stage colon cancer.\u003c/p\u003e \u003cp\u003eIn our study, the primary metastasis pathways of ileocecal tumors were lymph node groups 201, 202, and 203. Tumors of the ascending colon exhibited extensive metastasis to both proximal and distal lymph nodes, which may be attributed to the absence of right colonic vessels. We observed a common trend of L3 lymph node metastasis in tumors of the colonic hepatic flexure, which is consistent with the findings reported by Hasegawa et al\u003csup\u003e20\u003c/sup\u003e. The metastasis pattern of transverse colon tumors was predominantly concentrated in groups 221, 222, and 223, suggesting an association with the right branch of the middle colic artery. The findings of Park et al. regarding lymph node metastasis in ileocecal and ascending colon cancer are consistent with our data\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. However, our study suggests that the routine dissection of GCLN in right-sided colon cancer should be reevaluated, as it imposes additional surgical risks and our findings showed a lower-than-expected GCLN metastasis rate\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe also investigated the risk factors associated with SLNM and TD, and found that poorly differentiated tumors significantly increased the risk of SLNM. This indicates that extended lymph node dissection may be necessary for such cases\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. The association between TD and poor prognosis highlights the importance of prudent surgical decision-making, particularly in female patients and those with perineural invasion\u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Our ongoing long-term follow-up study aims to provide more valuable insights for clinical treatment.\u003c/p\u003e \u003cp\u003eOur findings challenge the conventional approach of preserving the ileocecal valve in surgeries for hepatic flexure and transverse colon cancers located more than 10 cm from the ileocecal region\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan additionalcitationids=\"CR25 CR26 CR27\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. The observed lymph node metastasis cases suggest potential risks associated with retaining the ileocecal region during right hemicolectomy. A deeper understanding of lymph node metastasis patterns and individualized surgical planning based on these patterns may improve patient outcomes while avoiding residual lesions.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study had several limitations. First, it was a single-center observational study conducted in a teaching hospital, leading to a potential selection bias toward patients with more advanced disease, such as lymph node or distant metastasis. Notably, most patients who had received neoadjuvant chemotherapy were excluded from this study, resulting in a smaller-than-expected sample size that requires further expansion in future studies. Additionally, long-term follow-up data are needed to evaluate long-term complications, quality of life, recurrence, and survival outcomes. Nevertheless, all data required for this study were prospectively collected without missing values, ensuring the reliability of the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the necessity of complete mesocolic excision (CME) combined with central vascular ligation (CVL) for patients with right-sided colon cancer, underscoring its favorable safety profile. However, routine dissection of gastrocolic ligament lymph nodes (GCLN) is not routinely indicated in all cases. The analysis identifies poorly differentiated tumors as significant high-risk factors for skipped lymph node metastasis (SLNM). Additionally, female patients and those with perineural invasion are at an increased risk of developing tumor deposits (TD). This research emphasizes the need for further survival analysis to verify the long-term benefits of combining CME, CVL, and GCLN dissection in the treatment of right-sided colon cancer.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest among the authors in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL.Y., J.H.P., Z.Z.P., and J.Z.L. conceived and designed the project. L.Y., B.L., and Y.X.D. collected the data. J.B.Z., W.H.L., B.Y.X., Y.L., W.H.F., W.H.Z., X.J.W., Z.H.L. and L.R.L. analyzed and interpreted the data. L.Y. and J.H.P. drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Bethune-Ethicon Excellence Surgery Fund [to J.Z.L.]. This work was supported by the grants from National Natural Science Foundation of China [82203461 to B.L.]. Guangzhou Science and Technology Project [202201011314 to B.L.]. Guangdong Medical Science and Technology Research Foundation [2019111811570248 to B.L.].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective observational study involving human participants was conducted in strict accordance with the principles of the \u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e (https://www.wma.net/policies-post/wma-declaration-of-helsinki/). The study protocol was reviewed and approved by the Ethics Committee of Sun Yat-Sen University Cancer Center (Approval No.: B2019-071-07). All participants (or their legally authorized representatives) were fully informed of the study objectives, procedures, potential risks, and benefits prior to enrollment. Written informed consent was obtained from each participant before any study-related procedures were performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot Applicable\u003c/strong\u003e. This manuscript does not contain any individual person\u0026rsquo;s identifiable images or clinical details that could compromise participant anonymity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to privacy and ethical restrictions related to patient clinical information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSungH,FerlayJ,SiegelRL,etal.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.Cancer J Clin.2021;71(3):209\u0026ndash;249.doi:10.3322/caac.21660.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkagiY,AdachiY,KinugasaT,OkaY,MizobeT,ShirouzuK.LymphNodeEvaluationandSurvivalinColorectalCancer:ReviewofPopulation-based,ProspectiveStudies.\u003cem\u003eANTICANCER RESEARCH\u003c/em\u003e.Publishedonline2013:9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJinM,FrankelWL.Lymph Node Metastasis in Colorectal Cancer.Surg Oncol Clin N Am.2018;27(2):401\u0026ndash;412.doi:10.1016/j.soc.2017.11.011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJamiesonJK,DobsonJF.THE LYMPHATICS OFTHE COLON. WITH SPECIAL REFERENCE TO THE OPERATIVE TREATMENT OF CANCER OF THE COLON:Ann Surg.1909;50(6):1077\u0026ndash;1090.doi:10.1097/00000658-190912000-00007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToyotaS,OhtaH,AnazawaS.Rationale for extent of lymph node dissection for right colon cancer.Dis Colon Rectum.1995;38(7):705\u0026ndash;711.doi:10.1007/bf02048026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertelsenCA,BolsB,IngeholmP,etal.Lymph Node Metastases in the Gastrocolic Ligament in Patients With Colon Cancer.Dis Colon Rectum.2014;57(7):839\u0026ndash;845.doi:10.1097/dcr.0000000000000144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHohenbergerW,WeberK,MatzelK,PapadopoulosT,MerkelS.Standardized surgery for colonic cancer: complete mesocolic excision and central ligation - technical notes and outcome.Colorectal Dis.2009;11(4):354\u0026ndash;364.doi:10.1111/j.1463-1318.2008.01735.x.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUematsuD,AkiyamaG,SugiharaT,MagishiA,YamaguchiT,SanoT.Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure: Lymph node dissection for colon cancer.Asian J Endosc Surg.2017;10(1):23\u0026ndash;27.doi:10.1111/ases.12311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeeSD,LimSB.D3 lymphadenectomy using a medial to lateral approach for curable right-sided colon cancer.Int J Colorectal Dis.2009;24(3):295\u0026ndash;300.doi:10.1007/s00384-008-0597-7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiangJT,LaiHS,HuangJ,SunCT.Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes.Surg Endosc.2015;29(8):2394\u0026ndash;2401.doi:10.1007/s00464-014-3940-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSunY,ZhangD,FengY,etal.Infrapyloric lymph node dissection in right hemicolectomy for colon cancer: Should prophylactic resection be recommended?J Surg Oncol.2021;123(S1).doi:10.1002/jso.26388.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBauerKM,HummonAB,BuechlerS.Right-side and left-side colon cancer follow different pathways to relapse: RELAPSE IN RIGHT-SIDE AND LEFT-SIDE COLON CANCER.Mol Carcinog.2012;51(5):411\u0026ndash;421.doi:10.1002/mc.20804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKataokaK,BeppuN,ShiozawaM,etal.Colorectal cancer treated by resection and extended lymphadenectomy: patterns of spread in left- and right-sided tumours.Br J Surg.2020;107(8):1070\u0026ndash;1078.doi:10.1002/bjs.11517.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasnetS,LouQfeng,LiuN,etal.Tumor deposit is an independent prognostic indicator in patients who underwent radical resection for colorectal cancer.J Cancer.2018;9(21):3979\u0026ndash;3985.doi:10.7150/jca.27475.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeltEJTh,vanStijnMFM,BrilH,etal.Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III.Ann Surg Oncol.2010;17(12):3203\u0026ndash;3211.doi:10.1245/s10434-010-1152-7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuppaG,UenoH,KayaharaM,etal.Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases.Mod Pathol.2009;22(3):410\u0026ndash;415.doi:10.1038/modpathol.2008.198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiM,ZhangH,YaoG,etal.The Role of Tumor Deposits in Predicting the Efficacy of Chemotherapy in Stage III Colon Cancer.Front Oncol.2020;10:586603.doi:10.3389/fonc.2020.586603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaquetteIM,MadoffRD,SigurdsonER,ChangGJ.Impact of Proximal Vascular Ligation on Survival of Patients with Colon Cancer.Ann Surg Oncol.2018;25(1):38\u0026ndash;45.doi:10.1245/s10434-016-5720-3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanemitsuY,KomoriK,KimuraK,KatoT.D3 Lymph Node Dissection in Right Hemicolectomy with a No-touch Isolation Technique in Patients With Colon Cancer.Dis Colon Rectum.2013;56(7):815\u0026ndash;824.doi:10.1097/dcr.0b013e3182919093.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasegawaS,KawamuraJ,NagayamaS,NomuraA,KondoK,SakaiY.Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers.Surg Endosc.2007;21(9):1657\u0026ndash;1657.doi:10.1007/s00464-007-9305-x.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParkIJ,ChoiGS,KangBM,LimKH,JunSH.Lymph Node Metastasis Patterns in Right-Sided Colon Cancers: Is Segmental Resection of These Tumors Oncologically Safe?Ann Surg Oncol.2009;16(6):1501\u0026ndash;1506.doi:10.1245/s10434-009-0368-x.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCUIYcheng,GAO Zdong,HAN L.High risk factors of lymphatic metastasis pattern of right colon neoplasms: a single-center prospective observational study.Chin J Practical Surg.2015;35(06):659\u0026ndash;663.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiuF,ZhaoJ,LiC,etal.The unique prognostic characteristics of tumor deposits in colorectal cancer patients.Ann Transl Med.2019;7(23):769\u0026ndash;769.doi:10.21037/atm.2019.11.69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKangSI,KimDW,ShinE,etal.Clinical Significance of Lymph Node Metastasis in the Mesentery of the Terminal Ileum in Patients With Right-sided Colon Tumors at Different Locations.Dis Colon Rectum.2018;61(6):692\u0026ndash;697.doi:10.1097/dcr.0000000000001048.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEfetovSK,ZubayraevaAA,NekovalVM,TyanAS,TulinaIA,TsarkovPV.Extended Colectomy Followed by Cecorectal Anastomosis as a Surgical Treatment Modality in Synchronous Colorectal Cancer.Case Rep Oncol.2020;13(2):813\u0026ndash;821.doi:10.1159/000508266.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandoEDPS,DeenKI.Consideration of the blood supply of the ileocecal segment in valve preserving right hemicolectomy.Clin Anat.2009;22(6):712\u0026ndash;715.doi:10.1002/ca.20838.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuH,WuH,MuB,etal.The feasibility and safety of complete laparoscopic extended right hemicolectomy with preservation of the ileocecal junction in right-transverse colon cancer.World J Surg Onc.2020;18(1):159.doi:10.1186/s12957-020-01922-8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePratapA,FlemingJB,BarnettCC.Right hemicolectomy using ileocecal pedicel flap\u0026mdash;a new technique for ileocecal sphincter preservation in complex Crohn\u0026rsquo;s disease with right sided colon cancer.Int J Colorectal Dis.2016;31(9):1669\u0026ndash;1670.doi:10.1007/s00384-016-2601-y.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gastrocolic Ligament Lymph Node Dissection, Risk Factors, Right Hemicolectomy","lastPublishedDoi":"10.21203/rs.3.rs-8593596/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8593596/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThis prospective observational study aims to evaluate the necessity of gastrocolic ligament lymph node (GCLN) dissection in the treatment of right-sided colon cancer, with a focus on the prevalence of lymph node metastasis and associated risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eBetween October 2019 and December 2021, 154 patients diagnosed with right-sided colon cancer underwent complete mesocolic excision (CME), central vascular ligation (CVL), and gastrocolic ligament lymph node (GCLN) dissection. Lymph node stations were defined in accordance with the criteria of the Japanese Society for Cancer of the Colon and Rectum, and the incidence of lymph node metastasis at each station was documented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe median number of GCLN was one, with a 0.65% metastasis rate observed in one patient. Multivariate analysis revealed poorly differentiated pathological grade (P = 0.038) as a significant risk factor for skipped metastasis. Additionally, female gender (p = 0.012) and perineural invasion (p = 0.004) were significant for tumor deposits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003e​ Based on the findings of this study, routine gastrocolic ligament lymph node (GCLN) dissection is not routinely indicated in all patients undergoing surgery for right-sided colon cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registry: \u003c/strong\u003eChinese Clinical Trial Registry (ChiCTR), http://www.chictr.org.cn/\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration Number: \u003c/strong\u003eChiCTR2100042014\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration Date:\u003c/strong\u003e2019-1-1\u003c/p\u003e","manuscriptTitle":"Assessment of the Necessity of Gastrocolic Ligament Lymph Node Dissection and Related Risk Factors in Right Hemicolectomy for Colon Cancer: A Prospective Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-22 16:56:23","doi":"10.21203/rs.3.rs-8593596/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d89f2eb-9b24-4681-8ecf-48239f6f3da9","owner":[],"postedDate":"February 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T01:25:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-22 16:56:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8593596","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8593596","identity":"rs-8593596","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}