Predictors of adequate lymph node harvest during colectomy for colon cancer

Douaiher, Jeffrey; Hussain, Tanvir; Langenfeld, Sean J.

doi:10.1016/j.amjsurg.2018.08.020

Cited by 19 publications

(27 citation statements)

References 40 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Foo

Wei

et al. 2020

World J Surg Onc

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Background: According to the American Joint Committee on Cancer staging for cancer of the colon, a minimum of 12 lymph nodes (LN) has to be sampled for accurate staging. This has bearing on the long-term prognosis and the need for adjuvant chemotherapy. The aim of this study was to revisit the association of lymph node yield and the long-term survival in patients with stages I and II, i.e. node-negative, colon cancer. Method: Consecutive patients who underwent elective or emergency curative resections for cancer of colon between the years 2003 and 2012 were retrospectively reviewed. Only patients with stage I or II diseases (AJCC 8th edition) were included. They were analysed in three groups, LN<12, LN12-19 and LN≥20. Their clinic-pathological characteristics were compared. The disease-free (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Results: There was a total of 659 patients included in the analysis. Twelve or more LN were found in 65.6% of the specimens. The mean follow-up was 83.9 months. LN≥20 had significantly better DFS (p = 0.015) and OS (p = 0.036), whereas LN<12 had similar DFS and OS when compared to LN12-19. The advantage in DFS and OS were mainly seen in those with stage II diseases. A lymph node yield of greater than 20 was one of the predictors of favourable DFS, hazard ratio 0.358; 95% CI 0.170-.756, p = 0.007. Conclusion: The lymph node yield had a significant association with survival outcomes. A lymph node yield of 20 or more was associated with better survival outcomes. On the other hand, lymph node yield less than 12 was not shown to have inferior survival outcomes when compared to those between 12 and 19.

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Section: Discussionmentioning

confidence: 99%

“…Patients in the LN≥20 group were younger, had a lower ASA grade, had bigger tumours and were less likely to be operated with the open approach. Prior studies showed that bigger tumours and younger age were associated with a higher lymph node yield [11,16]. Surgeons in the unit followed a standardized operative approach.…”

Section: Discussionmentioning

confidence: 99%

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

Foo

Wei

et al. 2020

World J Surg Onc

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“…While the benefit and safety of MIS colectomy has been well‐established, 2,16‐18 the adequacy of lymphadenectomy using laparoscopic and robotic approaches is still being investigated. In a recent meta‐analysis, Wu et al 19 found that laparoscopic and open colectomy were similar in their ability to meet the 12‐LN benchmark, whereas Douaiher et al 20 report in an analysis of the ACS National Surgery Quality Improvement Program database that colectomies performed using MIS techniques were actually more likely than those performed open to harvest 12 or more LNs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of open and minimally invasive approaches to colon cancer resection in compliance with 12 regional lymph node harvest quality measure

Williams

Sun

Kakade

et al. 2021

Journal of Surgical Oncology

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Background There has been a growing trend toward minimally invasive surgery (MIS) for colon cancer. Pathological analysis of a minimum of 12 lymph nodes (LNs) is a benchmark for adequate resection. Here, we present a comparison of surgical techniques in achieving a full oncologic resection. Methods Patients undergoing surgery for Stage I–III colon cancer (2010–2016) were identified from the National Cancer Database. Cases were stratified by surgical approach. Trends in approach were assessed, including whether the 12‐LN benchmark was met. Uni‐ and multivariate regression was used to assess overall survival (OS). Results A total of 290,776 colectomies were analyzed. MIS increased from 32.8% to 57.2% from 2010 to 2016 (p < .001). An overall median of 18 LNs were harvested and compliance with the 12‐LN benchmark increased (84.6%–91.6%, p < .001); there were no difference between open and MIS. A subset analysis comparing hospital type revealed that regardless of approach, compliance was lower at community hospitals (p < .001). OS was better for patients treated at academic or National Cancer Institute centers, underwent MIS, and in those meeting the 12‐LN benchmark (all p ≤ .002). Conclusion As MIS colon resections continue to increase, we demonstrate that there is no difference in the ability to achieve the 12‐LN benchmark with open and MIS approaches.

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“…20 Similar findings have been demonstrated for robotic surgery in other areas of surgical oncology. 21,22 In light of the theoretical advantages of MIS LP, the increasing use of robotic surgery 19 and the short-term benefits of robotics over laparoscopy, 23 the oncologic outcomes of MIS LP should be re-evaluated. The aim of this study is to determine the effect of MIS on long-term oncologic outcomes for resection of PDAC in a national database.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 and does not transmit haptic feedback, patient outcomes for robotic surgery have been similar to or better than traditional laparoscopy. Studies of patients undergoing robotic gastrectomy22 and robotic colectomy21 have demonstrated improved lymph node retrieval. In a single-institution series of patients undergoing MIS LP between 2004-2011, the authors found that even though the robot was used more for patients with previous surgery or patients with cancer, the robotic approach was associated with shorter operative time, less estimated blood loss, and a lower conversion to open rate 20.…”

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confidence: 99%

Improved oncologic outcomes for minimally invasive left pancreatectomy: Propensity‐score matched analysis of the National Cancer Database

Watson

Baimas-George

Thompson

et al. 2020

Journal of Surgical Oncology

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Background and objectives: Minimally invasive (MIS) left pancreatectomy (LP) is increasingly used to treat pancreatic adenocarcinoma (PDAC). Despite improved short-term outcomes, no studies have demonstrated long-term benefits over open resection. Methods: The National Cancer Database was queried between 2010 and 2016 for patients with PDAC, grouped by surgical approach (MIS vs open). Demographics, comorbidities, clinical staging, and pathologic staging were used for propensity-score matching. Perioperative, short-term oncologic, and survival outcomes were compared. Results: After matching, both cohorts included 805 patients. There were no differences in baseline characteristics, staging, or preoperative therapy between cohorts. The MIS cohort had a shorter length of stay (6.8 ± 5.5 vs 8.5 ± 7.3 days; P < .0001) with the trend toward improved time to chemotherapy (53.9 ± 26.1 vs 57.9 ± 29.9 days; P = .0511) and margin-positive resection rate (15.3% vs 18.9%; P = .0605). Lymph node retrieval and receipt of chemotherapy were similar. The MIS cohort had higher median overall survival (28.0 vs 22.1 months; P = .0067). Subgroup analysis demonstrated the highest survival for robotic compared with laparoscopic and open LP (41.9 vs 26.6 vs 22.1 months; P < .0001). Conclusions: This study demonstrates the safety of MIS LP and favorable long-term oncologic outcomes. The improved survival after MIS LP warrants further study with prospective, randomized trials.

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Predictors of adequate lymph node harvest during colectomy for colon cancer

Cited by 19 publications

References 40 publications

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

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

Comparison of open and minimally invasive approaches to colon cancer resection in compliance with 12 regional lymph node harvest quality measure

Improved oncologic outcomes for minimally invasive left pancreatectomy: Propensity‐score matched analysis of the National Cancer Database

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