Lymph Node Yield in Colon Cancer: Individuals Can Make the Difference

Abstract

Aim: To investigate the influence of individual surgeons and pathologists on examining an adequate (i.e. ≥10) number of lymph nodes in colon cancer resection specimens. Patients and Methods: The number of lymph nodes was evaluated in surgically treated patients for colon cancer at our hospital from 2008 through 2010, excluding patients who had received neo-adjuvant treatment. The patient group consisted of 156 patients with a median age of 73 (interquartile range (IQR) 63-82 years) and a median of 12 lymph nodes per patient (IQR 8-15). In 106 patients (67.9%), 10 or more nodes were histopathologically examined. Results: At univariate analysis, the examination of ≥10 nodes was influenced by tumour size (p = 0.05), tumour location (p = 0.015), type of resection (p = 0.034), individual surgeon (p = 0.023), and pathologist (p = 0.005). Neither individual surgeons nor pathologists did statistically and significantly influence the chance of finding an N+ status. Age (p = 0.044), type of resection (p = 0.007), individual surgeon (p = 0.012) and pathologist (p = 0.004) were independent prognostic factors in a multivariate model for finding ≥10 nodes. Conclusion: Though cancer staging was not affected in this study, individual efforts by surgeons and pathologists play a critical role in achieving optimal lymph node yield through conventional methods.

How does lymph node yield affect survival outcomes of stage I and II colon cancer?

“…Apart from technical factors like the extent of resection, it also depends on factors that were not controllable by surgeons. Studies have shown that a higher lymph node yield was more likely seen in young age, right-sided resection, advanced T and N stage and greater tumour size [11][12][13][14][15]. The lymph node yield within an institution was also shown to be increasing at a rate of 2-3% per year [16].…”

Compliance to D2 lymphadenectomy in laparoscopic gastrectomy

“…Last but not least, the pathologist should be involved actively in the process of identification of separate lymph-node stations. It is known that, in colorectal surgery, the individual pathologist can make a difference in the number of harvested lymph nodes [ 34 ].…”

Survival after resection of appendiceal carcinoma by hemicolectomy and less radical than hemicolectomy: a population‐based propensity score matched analysis

“…Previous research has proposed RH not only in an effort to improve oncological outcome by resection of lymph node metastases but also because the associated lymphadenectomy might enable better staging . Yada et al .…”

“…Previous research has proposed RH not only in an effort to improve oncological outcome by resection of lymph node metastases but also because the associated lymphadenectomy might enable better staging [5,31]. Yada et al [32] analysed the arterial branching patterns and lymph node metastases in 344 colon cancer patients.…”