Resecting Lymph Nodes in Colon Cancer: More than a Staging Operation?

Excerpt

Lee et al.1 present a retrospective study of 201 patients with stage-III colon cancer and examine the prognostic impact of lymph node ratio, defined as the percentage of resected lymph nodes that are positive for tumor. This review adds to the mounting evidence that tumor status of resected lymph nodes remains the single most important prognostic factor but can be further defined for staging purposes and perhaps quality assessment. Impressively, when lymph node ratio was no greater than 25%, disease-free survival dropped from over 83% to 27% in patients with N1 disease and from 100% to 17% in patients with N2 disease. The persistence of this effect is intriguing and begs the question of whether there is therapeutic value in attempting to achieve a low lymph node ratio, particularly if it does not change the stage of disease. In other words, is it necessary to clear the relevant lymph node basins? …