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Published in: International Journal of Colorectal Disease 1/2008

01-01-2008 | Original Article

Factors influencing lymph node harvest in colorectal surgery

Authors: M. Gelos, J. Gelhaus, P. Mehnert, G. Bonhag, M. Sand, S. Philippou, B. Mann

Published in: International Journal of Colorectal Disease | Issue 1/2008

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Abstract

Background and aims

Lymphadenectomy in colorectal cancer is a critical component concerning prognosis and survival of patients. Several variables influence the number of harvested lymph nodes (LN). However, results of studies are contradictory, and influencing factors remain to be identified. The aim of the present study was to identify factors that have a significant influence on the number of assessed LN in oncologic colorectal cancer resection.

Materials and methods

Three hundred and forty-one patients (190 men and 151 women), who underwent a colorectal cancer resection in a curative intention in the years 2000–2005, were analysed retrospectively. All specimens were histologically examined by two pathologists.

Results

In a median, 15.1 LN per operation were resected. Early tumour stage (p < 0.01), length of resected bowel segment (p < 0.05) and right-sided location (p < 0.001) had a significant influence on the number of resected LN. Age, gender, surgeon volume, differentiation of the tumour, LN metastases, lymphatic invasion and depth of tumour invasion had no significant association with harvested LN number. Furthermore, the presence or absence of the vermiform appendix and the length of the resected ileum segment in right-sided resections did not significantly affect the assessed LN.

Conclusion

The question arises whether for colorectal cancers of all locations the same amount of resected and analysed LNs should be lasting to fulfill oncologic criteria, as the number of harvested LNs depends on several parameters.
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Literature
1.
go back to reference Cohen AM, Tremiterra S, Candela F, Thaler HT, Sigurdson ER (1991) Prognosis of node-positive colon cancer. Cancer 67:1859–1861PubMedCrossRef Cohen AM, Tremiterra S, Candela F, Thaler HT, Sigurdson ER (1991) Prognosis of node-positive colon cancer. Cancer 67:1859–1861PubMedCrossRef
2.
go back to reference Allegra C, Sargent DJ (2005) Adjuvant therapy for colon cancer–the pace quickens. N Engl J Med 352:2746–2748PubMedCrossRef Allegra C, Sargent DJ (2005) Adjuvant therapy for colon cancer–the pace quickens. N Engl J Med 352:2746–2748PubMedCrossRef
3.
go back to reference Sargent DJ, Wieand HS, Haller DG (2005) Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 23:8664–8670PubMedCrossRef Sargent DJ, Wieand HS, Haller DG (2005) Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 23:8664–8670PubMedCrossRef
4.
go back to reference Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, Tabah-Fisch I (2004) Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) Investigators. N Engl J Med 350:2343–2351PubMedCrossRef Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, Tabah-Fisch I (2004) Multicenter International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) Investigators. N Engl J Med 350:2343–2351PubMedCrossRef
5.
go back to reference Hernanz F, Revuelta S, Redondo C, Madrazo C, Castillo J, Gomez-Fleitas M (1994) Colorectal adenocarcinoma: quality of the assessment of lymph node metastases. Dis Colon Rectum 37:373–376PubMedCrossRef Hernanz F, Revuelta S, Redondo C, Madrazo C, Castillo J, Gomez-Fleitas M (1994) Colorectal adenocarcinoma: quality of the assessment of lymph node metastases. Dis Colon Rectum 37:373–376PubMedCrossRef
6.
go back to reference Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, Ballario E, Becchi G, Bonilauri S, Carobbi A, Cavaliere P, Garcea D, Giuliani L, Morziani E, Mosca F, Mussa A, Pasqualini M, Poddie D, Tonetti F, Zardo L, Rosso R (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 235:458–463PubMedCrossRef Prandi M, Lionetto R, Bini A, Francioni G, Accarpio G, Anfossi A, Ballario E, Becchi G, Bonilauri S, Carobbi A, Cavaliere P, Garcea D, Giuliani L, Morziani E, Mosca F, Mussa A, Pasqualini M, Poddie D, Tonetti F, Zardo L, Rosso R (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 235:458–463PubMedCrossRef
7.
go back to reference Goldstein NS, Sanford W, Coffey M, Layfield LJ (1996) Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 106:209–216PubMed Goldstein NS, Sanford W, Coffey M, Layfield LJ (1996) Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 106:209–216PubMed
8.
go back to reference Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:414–415CrossRef Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:414–415CrossRef
9.
go back to reference Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2005) Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 34:8706–8712CrossRef Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2005) Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 34:8706–8712CrossRef
10.
go back to reference Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRef Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRef
12.
go back to reference Reinbach DH, McGregor JR, Murray GD, O’Dwyer PJ (1994) Effect of the surgeon’s specialty interest on the type of resection performed for colorectal cancer. Dis Colon Rectum 37:1020–1023PubMedCrossRef Reinbach DH, McGregor JR, Murray GD, O’Dwyer PJ (1994) Effect of the surgeon’s specialty interest on the type of resection performed for colorectal cancer. Dis Colon Rectum 37:1020–1023PubMedCrossRef
13.
go back to reference Jestin P, Pahlman L, Glimelius B, Gunnarsson U (2005) Cancer staging and survival in colon cancer is dependent on the quality of the pathologists’ specimen examination. Eur J Cancer 41:2071–2078PubMedCrossRef Jestin P, Pahlman L, Glimelius B, Gunnarsson U (2005) Cancer staging and survival in colon cancer is dependent on the quality of the pathologists’ specimen examination. Eur J Cancer 41:2071–2078PubMedCrossRef
14.
go back to reference Evans MD, Rees A, Stamatakis JD, Karandikar SS (2006) Factors influencing lymph node retrieval in colorectal cancer and its effect on survival. Colorectal Dis 8:721–722CrossRef Evans MD, Rees A, Stamatakis JD, Karandikar SS (2006) Factors influencing lymph node retrieval in colorectal cancer and its effect on survival. Colorectal Dis 8:721–722CrossRef
15.
go back to reference Horzic M, Kopljar M (2005) Minimal number of lymph nodes that need to be examined for adequate staging of colorectal cancer—factors influencing lymph node harvest. Hepato-Gastroenterology 52:86–89PubMed Horzic M, Kopljar M (2005) Minimal number of lymph nodes that need to be examined for adequate staging of colorectal cancer—factors influencing lymph node harvest. Hepato-Gastroenterology 52:86–89PubMed
16.
go back to reference Johnson PM, Malatjalian D, Porter GA (2002) Adequacy of nodal harvest in colorectal cancer: a consecutive cohort study. J Gastrointest Surg 6:883–890PubMedCrossRef Johnson PM, Malatjalian D, Porter GA (2002) Adequacy of nodal harvest in colorectal cancer: a consecutive cohort study. J Gastrointest Surg 6:883–890PubMedCrossRef
17.
go back to reference Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225PubMedCrossRef Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225PubMedCrossRef
18.
go back to reference Wright FC, Law CH, Last L, Khalifa M, Arnaout A, Naseer Z, Klar N, Gallinger S, Smith AJ (2003) Lymph node retrieval and assessment in stage II colorectal cancer: a population-based study. Ann Surg Oncol 10:903–909PubMedCrossRef Wright FC, Law CH, Last L, Khalifa M, Arnaout A, Naseer Z, Klar N, Gallinger S, Smith AJ (2003) Lymph node retrieval and assessment in stage II colorectal cancer: a population-based study. Ann Surg Oncol 10:903–909PubMedCrossRef
19.
go back to reference Lanz T, Wachsmuth W (1993) Praktische anatomie. Bauch. Springer, Berlin Lanz T, Wachsmuth W (1993) Praktische anatomie. Bauch. Springer, Berlin
Metadata
Title
Factors influencing lymph node harvest in colorectal surgery
Authors
M. Gelos
J. Gelhaus
P. Mehnert
G. Bonhag
M. Sand
S. Philippou
B. Mann
Publication date
01-01-2008
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 1/2008
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-007-0378-8

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