Determinants of Lymph Node Yield and Involvement in Resectable Colon Cancer: A Study of Anatomical, Pathological, and Fresh, Nonfixed Specimen Dissection

Behera, Sandeep; Chandramohan, K; Muralee, Madhu; Saxena, Renu; Krishna, K M Jagathnath

doi:10.1007/s12262-023-03706-2

Cited by 3 publications

(6 citation statements)

References 24 publications

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“…In the systematic review, nine studies indicated no significant association between the degree of tumour differentiation and number of retrieved LNs 21 29 39 41 47 53 54 59 65. However, three studies suggested that more LNs could be obtained from poorly differentiated cancer 43 50 63.…”

Section: Resultsmentioning

confidence: 99%

“…From these articles, 90 articles were excluded because the papers were not in English or Chinese (n=2), had unavailable data (n=23) and were unrelated (n=65). Finally, 54 studies were included, with 30 included in the systematic review,5 19–47 and 24 in the meta-analysis (figure 1). 12–14 48–68…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review, 20 articles revealed no significant association between age and the retrieval of LNs in colorectal cancer 21–23 26 27 30 32 35 37–41 47–49 54 55 64 65. However, 18 articles indicated that more LNs were obtained from young patients than elderly patients (online supplemental table 6).…”

Section: Resultsmentioning

confidence: 99%

“…The analysis of gender and retrieved LNs in colorectal cancer using systematic review included ten colorectal cancer,21 26 27 31 32 36 37 39 41 51 five colon cancer22 30 35 44 47 and five rectal cancer studies 23 38 42 54 65. These studies showed that gender had no significant association with the LN yield.…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review of association between the T stage and LN yield in colorectal cancer, 12 studies mentioned that the T stage had no significant association with the LN yield,23 26 29 30 32 35 39 40 42 44 47 54 but eight articles revealed that more LNs were obtained from the advanced T stage than early T stage 21 25 27 28 37 41 51 62. Moreover, four articles mentioned that the T stage was associated with the harvested LNs,19 24 36 48 without explaining the specific association.…”

Section: Resultsmentioning

confidence: 99%

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Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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ObjectiveClinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.DesignSystematic review and meta-analysis of primary studies.Data sourcesPubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.Eligibility criteria for selecting studiesStudies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.Data extraction and synthesisOR with 95% conference intervals was extracted and pooled.ResultsA total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.ConclusionsThe study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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Outcomes of Minimally Invasive Rectal Cancer Resection: Insights From a Resource‐Limited Setting

Nadarajan,

Krishnan Nair,

Muralee

et al. 2024

Journal of Surgical Oncology

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BackgroundMinimally invasive approaches for rectal cancer treatment are emerging as the standard of care. Robotic surgery is unfeasible across the country due to constrained resource allocation. This study aimed to assess the oncologic efficacy of laparoscopic resection for rectal cancer in a resource‐limited setting.MethodsA propensity score‐matched analysis was carried out to compare the oncological outcomes of laparoscopic and open rectal cancer resection at a high‐volume tertiary cancer centre in South India.ResultsTwo hundred and twenty patients were included (110 patients in each group). The median follow‐up was 93 months. There was no difference in positive circumferential resection margin between laparoscopic and open group (4.5% vs. 6.4%, p = 0.55), with a significantly better nodal yield in laparoscopic group. There was no significant difference between the laparoscopic and open groups in terms of local recurrence (5.1% vs. 8.3%, p = 0.12), 5‐year disease‐free survival (86% vs. 81%, p = 0.22, HR 0.699, 95% CI 0.353–1.27) or overall survival (85% vs. 76%, p = 0.21, HR 0.658, 95% CI 0.340–1.27). The mean cost between the two groups had no difference.ConclusionIn a resource‐limited setting with good expertise, laparoscopic surgery is an effective minimally invasive option that has good survival outcomes without imposing a financial burden on patients.

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Improved Nodal Yields in Laparoscopic Right Hemicolectomy Using Intracorporeal Technique—A Comparative Study

Naseem,

Ho,

Tran

et al. 2024

Indian J Surg

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Right-sided colon cancer is now commonly treated by laparoscopic right hemicolectomy (LRH). The best procedure for mesentery dissection and nodal harvesting is still being debated. The purpose of this study is to compare precise intra-corporeal mesentery dissection (ICMD) with extra-corporeal mesentery dissection (ECMD) approaches and assess their impact on nodal harvest during LRH. This paper is also aimed at providing a detailed account of the customised intracorporeal dissection technique. A retrospective analysis of 78 operative cases was performed. The patients were divided into two groups: those with ICMD (n = 30) and those with ECMD (n = 48). The total number of lymph nodes extracted was the primary outcome. The number of positive lymph nodes, length of hospital stay, and surgical complications were some of the secondary objectives. The total number of lymph nodes extracted in the ICMD was considerably higher (p = 0.02). Cancers located in the ascending colon were associated with more lymph nodes than tumours located in the cecum or hepatic flexure (p = 0.001). This study demonstrates that ICMD provides improved nodal yield compared to ECMD in LRH for right-sided colon cancer. The anatomical location of cancer also impacts the nodal number, with tumours in the ascending colon having the highest yield. The findings underscore the importance of precise dissection technique selection to optimise oncological outcomes, suggesting potential further enhancements with the use of robotic surgical systems in accessing challenging anatomical locations.

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Determinants of Lymph Node Yield and Involvement in Resectable Colon Cancer: A Study of Anatomical, Pathological, and Fresh, Nonfixed Specimen Dissection

Cited by 3 publications

References 24 publications

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Outcomes of Minimally Invasive Rectal Cancer Resection: Insights From a Resource‐Limited Setting

Improved Nodal Yields in Laparoscopic Right Hemicolectomy Using Intracorporeal Technique—A Comparative Study

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