Top

Published in:

01-12-2011

Improved Lymph Node Harvest from Resected Colon Cancer Specimens Did Not Cause Upstaging from TNM Stage II to III

Authors: Kristian Storli, Karl Søndenaa, Bjørg Furnes, Sabine Leh, Idunn Nesvik, Tore Bru, Einar Gudlaugsson, Ida Bukholm, Solveig Norheim-Andersen, Geir Eide

Published in: World Journal of Surgery | Issue 12/2011

Abstract

Background

The number of lymph nodes retrieved and examined from a resected colon cancer specimen may be crucial for correct staging. We examined if efforts to increase the lymph node harvest to more than 12 lymph nodes per specimen would upstage some patients from TNM stage II to III.

Methods

Three hospitals compared results from 2000 with those of 2007 in 421 resected patients with stage II and III colon cancer. Hospital A endeavored to improve the surgical procedure while the pathologists enhanced the quality of lymph node sampling. Hospital B did not make any marked changes, while hospital C introduced the GEWF lymph node solvent (glacial acetic acid, ethanol, distilled water, and formaldehyde) in their pathology method.

Results

In 2000, 12 or more lymph nodes were harvested in 39.6, 45.0, and 21.1% of the specimens from the three hospitals, while the figures for 2007 were 85.7, 42.0, and 90.3%, respectively. The significant increase in lymph node harvest in two of the hospitals in 2007 compared to 2000 (p < 0.001) did not affect the share of patients with stage III in 2007 (38.7%) compared to 2000 (44.1%) (p = 0.260). The number of positive lymph nodes and the lymph node ratio (LNR) decreased from 2000 to 2007. A lymph node yield of 12 or more was not associated with an increased probability of positive lymph nodes in a multivariable logistic regression analysis.

Conclusion

More radical surgery and dedicated pathologists and the use of the GEWF solvent significantly increased the lymph node yield but did not upstage patients from TNM stage II to III.

Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11:354–364 discussion 364–365PubMedCrossRef

Tsai HL, Lu CY, Hsieh JS, Wu DC, Jan CM, Chai CY, Chu KS, Chan HM, Wang JY (2007) The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg 11:660–665PubMedCrossRef

Swanson RS, Compton CC, Stewart AK, Bland KI (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71PubMedCrossRef

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

Kelder W, Inberg B, Schaapveld M, Karrenbeld A, Grond J, Wiggers T, Plukker JT (2009) Impact of the number of histologically examined lymph nodes on prognosis in colon cancer: a population-based study in the Netherlands. Dis Colon Rectum 52:260–267PubMedCrossRef

Polignano F, Henderson N, Alishahi SM, Zito A (2006) Laparoscopic colectomy for cancer and adequate lymphadenectomy: association between survival and number of lymph nodes. Surg Endosc 20:996–997PubMedCrossRef

Storli K, Lindboe CF, Kristoffersen C, Kleiven K, Søndenaa K (2010) Lymph node harvest in colon cancer specimens depends on tumour factors, patients and doctors, but foremost on specimen handling. APMIS 119:127–134PubMedCrossRef

Sjövall A, Granath F, Cedermark B, Glimelius B, Holm T (2006) Loco-regional recurrence from colon cancer: a population-based study. Ann Surg Oncol 14:432–440PubMedCrossRef

Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O, Birkmeyer JD (2007) Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 298:2149–2154PubMedCrossRef

10.

Hsu CW, Lin CH, Wang JH, Wang HT, Ou WC, King TM (2009) Factors that influence 12 or more harvested lymph nodes in early-stage colorectal cancer. World J Surg 33:333–339. doi:10.1007/s00268-008-9850-z PubMedCrossRef

11.

Nedrebø BS, Søreide K, Eriksen MT, Dørum LM, Kvaløy JT, Søreide JA, Kørner H (2011) Survival effect of implementing national treatment strategies for curatively resected colonic and rectal cancer. Br J Surg 98:716–723PubMedCrossRef

12.

Feinstein AR, Sosin DM, Wells CK (1985) The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 312:1604–1608PubMedCrossRef

13.

Bui L, Rempel E, Reeson D, Simunovic M (2006) Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: a population-based study. J Surg Oncol 93:439–445PubMedCrossRef

14.

Iversen LH, Laurberg S, Hagemann-Madsen R, Dybdahl H (2008) Increased lymph node harvest from colorectal cancer resections using GEWF solution: a randomised study. J Clin Pathol 61:1203–1208PubMedCrossRef

15.

Baxter NN, Ricciardi R, Simunovic M, Urbach DR, Virnig BA (2010) An evaluation of the relationship between lymph node number and staging in pT3 colon cancer using population-based data. Dis Colon Rectum 53:65–70PubMedCrossRef

16.

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

17.

Rosenberg R, Engel J, Bruns C, Heitland W, Hermes N, Jauch KW, Kopp R, Pütterich E, Ruppert R, Schuster T, Friess H, Hölzel D (2010) The prognostic value of lymph node ratio in a population-based collective of colorectal cancer patients. Ann Surg 251:1070–1078PubMedCrossRef

18.

Merrie AE, Phillips LV, Yun K, McCall JL (2001) Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection. Surgery 129:684–691PubMedCrossRef

19.

Bilchik A, Nissan A, Wainberg Z, Shen P, McCarter M, Protic M, Howard R, Elashoff D, Tyler J, Peoples GE, Stojadinovic A (2010) Surgical quality and nodal ultrastaging is associated with long-term disease-free survival in early colorectal cancer. Ann Surg 252:467–476PubMed

20.

Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, Kameoka S, Saito Y, Takahashi K, Hase K, Oya M, Maeda K, Hirai T, Kameyama M, Shirouzu K, Muto T (2007) Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 141:67–75PubMedCrossRef

21.

Wang J, Kulaylat M, Rockette H, Hassett J, Rajput A, Dunn KB, Dayton M (2009) Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg 249:559–563PubMedCrossRef

22.

Quirke P, Morris E (2007) Reporting colorectal cancer. Histopathology 50:103–112PubMedCrossRef

23.

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 23:8706–8712PubMedCrossRef

24.

Nagtegaal ID, Quirke P (2007) Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology 51:141–149PubMedCrossRef

25.

Sobin LGM, Wittekind C (eds) (2009) International union against cancer TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Hoboken

26.

West NP, Hohenberger W, Finan PJ, Quirke P (2009) Mesocolic plane surgery: an old but forgotten technique? Colorectal Dis 11:988–989PubMedCrossRef

27.

Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T (1997) Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg 21:109–115. doi:10.1007/s002689900202 PubMedCrossRef

28.

Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38:705–711PubMedCrossRef

29.

Nash GM, Row D, Weiss A, Shia J, Guillem JG, Paty PB, Gonen MR, Weiser M, Temple LK, Fitzmaurice G, Wong WD (2011) A predictive model for lymph node yield in colon cancer resection specimens. Ann Surg 253:318–322PubMedCrossRef

Title: Improved Lymph Node Harvest from Resected Colon Cancer Specimens Did Not Cause Upstaging from TNM Stage II to III
Authors: Kristian Storli
Karl Søndenaa
Bjørg Furnes
Sabine Leh
Idunn Nesvik
Tore Bru
Einar Gudlaugsson
Ida Bukholm
Solveig Norheim-Andersen
Geir Eide
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-011-1248-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improved Lymph Node Harvest from Resected Colon Cancer Specimens Did Not Cause Upstaging from TNM Stage II to III

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2011

Fast-Track Concepts in Major Open Upper Abdominal and Thoracoabdominal Surgery: A Review

Effect of Perioperative Intensive Insulin Therapy for Liver Dysfunction After Hepatic Resection

Severe Hepatic Trauma: Nonoperative Management, Definitive Repair, or Damage Control Surgery?

Elevation of Liver Function Tests After Laparoscopic Gastrectomy Using a Nathanson Liver Retractor

ISS/SIC Donors January 2011 thru June 2011

No Outcome Differences between a Laparoscopic and Retroperitoneoscopic Approach in Synchronous Bilateral Adrenal Surgery