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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2013

01-10-2013 | Colorectal Cancer

Less Than 12 Nodes in the Surgical Specimen After Total Mesorectal Excision Following Neoadjuvant Chemoradiation: It means more than you think!

Authors: Luiz Felipe de Campos-Lobato, Luca Stocchi, MD, FACS, FASCRS, João Batista de Sousa, Martin Buta, MD, Ian C. Lavery, MD, Victor W. Fazio, MD, David W. Dietz, MD, Matthew F. Kalady, MD

Published in: Annals of Surgical Oncology | Issue 11/2013

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Abstract

Background

A minimum of 12 examined lymph nodes (LN) is recommended to ensure adequate staging and oncologic resection of patients undergoing proctectomy for rectal adenocarcinoma. However, a decreased number of LN is not unusual in patients receiving neoadjuvant chemoradiation.

Purpose

We hypothesized that a decreased number of LN in the proctectomy specimen of these patients may be an indicator of tumor response and be associated with improved prognosis.

Methods

A single-center colorectal cancer database was queried for c-stage II–III rectal cancer patients undergoing neoadjuvant chemoradiation followed by proctectomy between 1997 and 2007. Patients were categorized into two groups according to the number of LN retrieved from the proctectomy specimen: <12 LN versus ≥12 LN. Groups were compared with respect to demographics, tumor and treatment characteristics, and the following oncologic outcomes: overall-survival (OS), cancer-specific-mortality (CSM), cancer-free-survival (CFS), distant (DR), and local recurrences (LR).

Results

The query returned 237 patients. There were 173 (73 %) males, and the median age was 57 years [interquartile range (IQR) 49–66 years]. The median number of LN retrieved was 15 (IQR 10–23) and 70 (30 %) patients had less than 12 nodes examined. The <12 nodes group was older [60 (IQR 51–71 years) vs. 55 (IQR 48–65 years), p = 0.009] and had more pathologic complete responders (36 vs. 19 %, p = 0.01). No <12 nodes patient experienced a LR, whereas the 5-year LR rate was 11 % in the ≥12 nodes group (p = 0.004). Other oncologic outcomes were not significantly different.

Conclusions

Retrieval of less than 12 nodes in the proctectomy specimen of rectal cancer patients treated with neoadjuvant chemoradiation does not affect OS, CSM, CFS, or DR and may be a marker of higher tumor response and, consequently, decreased LR rate.
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Metadata
Title
Less Than 12 Nodes in the Surgical Specimen After Total Mesorectal Excision Following Neoadjuvant Chemoradiation: It means more than you think!
Authors
Luiz Felipe de Campos-Lobato
Luca Stocchi, MD, FACS, FASCRS
João Batista de Sousa
Martin Buta, MD
Ian C. Lavery, MD
Victor W. Fazio, MD
David W. Dietz, MD
Matthew F. Kalady, MD
Publication date
01-10-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 11/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3010-x

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