Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 11/2006

01-11-2006

A National Study on Lymph Node Retrieval in Resectional Surgery for Colorectal Cancer

Authors: Paris P. Tekkis, M.D., F.R.C.S., Jason J. Smith, F.R.C.S., Alexander G. Heriot, F.R.C.S., Ara W. Darzi, F.R.C.S., Michael R. Thompson, F.R.C.S., Jeffrey D. Stamatakis, F.R.C.S., On behalf of the Association of Coloproctology of Great Britain and Ireland

Published in: Diseases of the Colon & Rectum | Issue 11/2006

Login to get access

Purpose

This study was designed to develop a mathematical model for predicting the number of lymph nodes harvested in bowel cancer resection specimens based on the current clinical practice in the United Kingdom.

Methods

Prospective clinical data were collected from 8,409 newly diagnosed bowel cancer patients presenting to 79 hospitals in Great Britain and Ireland during a variable 12-month period from 2000 to 2002. A two-level hierarchical regression model was used to identify predictors for lymph node harvest. The model was internally validated by comparing observed and model predicted lymph node harvest for patient subgroups.

Results

Inclusion criteria were satisfied by 5,164 patients. The average lymph node harvest was 11.7 nodes with significant between-center variability in lymph node harvest (range, 5.5–21.3 nodes). Increasing age, American Society of Anesthesiology grade, and preoperative radiotherapy were associated with a reduction of lymph node harvest (P < 0.001). Abdominoperineal resection of the rectum and transverse colectomy were the lowest yield procedures for lymph node harvest. Independent predictors of lymph node harvest were age, American Society of Anesthesiology grade, Dukes stage, operative urgency, type of resection, and preoperative radiotherapy. When tested, the model was found to accurately predict lymph node harvest for group statistics (comparison of observed and model predicted lymph node harvest F1,5154 = 0.63; P = 0.427).

Conclusions

The results of the study suggest that the minimum number of lymph nodes harvested in colorectal cancer surgery cannot be set at a fixed value. The lymph node harvest model provides a simple tool to the frontline clinician for comparing standards between multidisciplinary bowel cancer teams.
Literature
1.
Maurel, J, Launoy, G, Grosclaude, P,  et al. 1998Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based studyCancer8214821486PubMedCrossRef
2.
Cserni, G 1999Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based studyCancer85243245PubMedCrossRef
3.
Cserni, G, Vinh-Hung, V, Burzykowski, T 2002Is there a minimum number of lymph nodes that should be histologically assessed for a reliable nodal staging of T3N0M0 colorectal carcinomas?J Surg Oncol816369PubMedCrossRef
4.
Canessa, CE, Badia, F, Fierro, S, Fiol, V, Hayek, G 2001Anatomic study of the lymph nodes of the mesorectumDis Colon Rectum4413331336PubMedCrossRef
5.
Ratto, C, Sofo, L, Ippoliti, M,  et al. 1999Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significanceDis Colon Rectum42143154PubMedCrossRef
6.
Goldstein, NS, Sanford, W, Coffey, M, Layfield, LJ 1996Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recoveredAm J Clin Pathol106209216PubMed
7.
Caplin, S, Cerottini, JP, Bosman, FT, Constanda, MT, Givel, JC 1998For patients with Dukes B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosisCancer83666672PubMedCrossRef
8.
Swanson, RS, Compton, CC, Stewart, AK, Bland, KI 2003The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examinedAnn Surg Oncol106571PubMedCrossRef
9.
Guidance on Cancer Services. Improving Outcomes in Colorectal Cancers. Manual Update. London: National Institute for Clinical Excellence, 2004.
10.
Tekkis, PP, Poloniecki, JD, Thompson, MR, Stamatakis, JD 2003Operative mortality in colorectal cancer: prospective national studyBMJ32711961201PubMedCrossRef
11.
Dripps, RD, Lamont, A, Eckenhoff, JE 1961The role of anesthesia in surgical mortalityJAMA178261266PubMed
12.
NCEPOD. Then and now. The 2000 Report of the National Confidential Enquiry into Perioperative Deaths. London: The Royal College of Surgeons of England, 2000.
13.
Turnbull, RB,Jr, Kyle, K, Watson, FR, Spratt, J 1967Cancer of the colon: the influence of the no-touch isolation technic on survival ratesAnn Surg166420427PubMedCrossRef
14.
Goldstein, H, Browne, W, Rasbash, J 2002Multilevel modeling of medical dataStat Med2132913315PubMedCrossRef
15.
Prandi, M, Lionetto, R, Bini, A,  et al. 2002Prognostic eval-uation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trialAnn Surg235458463PubMedCrossRef
16.
Goldstein, NS 2002Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilitiesAm J Surg Pathol26179189PubMedCrossRef
17.
Cianchi, F, Palomba, A, Boddi, V,  et al. 2002Lymph node recovery from colorectal tumor specimens: recommendation for a minimum number of lymph nodes to be examinedWorld J Surg26384389PubMedCrossRef
18.
Voyer, TE, Sigurdson, ER, Hanlon, AL,  et al. 2003Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089J Clin Oncol2129122919PubMedCrossRef
19.
Scott, KW, Grace, RH, Gibbons, P 1994Five-year follow-up study of the fat clearance technique in colorectal carcinomaDis Colon Rectum37126128PubMedCrossRef
20.
Cserni, G 2002The influence of nodal size on the staging of colorectal carcinomasJ Clin Pathol55386390PubMedCrossRef
21.
Rodriguez-Bigas, MA, Maamoun, S, Weber, TK, Penetrante, RB, Blumenson, LE, Petrelli, NJ 1996Clinical significance of colorectal cancer: metastases in lymph nodes <5 mm in sizeAnn Surg Oncol3124130PubMedCrossRef
Metadata
Title
A National Study on Lymph Node Retrieval in Resectional Surgery for Colorectal Cancer
Authors
Paris P. Tekkis, M.D., F.R.C.S.
Jason J. Smith, F.R.C.S.
Alexander G. Heriot, F.R.C.S.
Ara W. Darzi, F.R.C.S.
Michael R. Thompson, F.R.C.S.
Jeffrey D. Stamatakis, F.R.C.S.
On behalf of the Association of Coloproctology of Great Britain and Ireland
Publication date
01-11-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 11/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0691-2

Other articles of this Issue 11/2006

Diseases of the Colon & Rectum 11/2006 Go to the issue

Letters to the Editor

The Authors Reply

OriginalPaper

Fibrin Glue as an Adjunct to Flap Repair of Anal Fistulas: A Randomized, Controlled Study

Report

Coloseminal Vesicle Fistula: Report of a Case and Review of the Literature

OriginalPaper

Effect of Aging on Anorectal and Pelvic Floor Functions in Females

Letters to the Editor

The Altemeier Procedure: New Technologies for an Old Technique

Announcement

Announcements