Colon Cancer Survival Is Associated With Increasing Number of Lymph Nodes Analyzed: A Secondary Survey of Intergroup Trial INT-0089

Voyer, Thomas E. Le; Sigurdson, Elin R.; Hanlon, Alexandra L.; Mayer, Robert J.; Macdonald, John S.; Catalano, Paul J.; Haller, Daniel G.

doi:10.1200/jco.2003.05.062

Cited by 1,021 publications

(759 citation statements)

References 16 publications

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“…This, along with the associated greater lymph node yield, may partially explain the high 5-year survival rates reported in Erlangen [13]. There was an increase in the number of negative lymph nodes with CME and CVL which has been linked to improved survival in both lymph node negative cases [14,15] and stage III disease [16]. West et al reported a greater lymph node yield (median, 30 vs. 18; p<0.0001) in high versus low ligation [13] In our study, the corresponding values are 33 and 25 (p= 0.048), thus establishing that high ligation produces oncologically superior specimen compared with standard low ligation surgery for carcinoma of the left colon and rectum.…”

Section: Discussionmentioning

confidence: 96%

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

Charan

Kapoor²,

Singhal³

et al. 2014

Indian J Surg

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During surgery for colorectal cancer, the inferior mesenteric artery (IMA) may be ligated either directly at the origin of the IMA from the aorta (high ligation) or at a point just below the origin of the left colic artery (low ligation). Sixty patients of left colonic and rectal cancer undergoing elective curative surgery in 2007 and 2008 were selected for this observational study. The resected lymph nodes were grouped into three levels: along the bowel wall (D1), along IMA below left colic (D2), and along the IMA and its root (D3). Statistical analysis was performed with SPSS version 20.0. D2 level was involved pathologically in 20 (33.3 %) and D3 in six out of 44 (13.6 %) patients. The median nodal yield with high and low ligation were 33 and 25, respectively (p= 0.048). Median overall survival for high ligation was 62 months versus 42 months for low ligation (p=0.190). High ligation of the IMA for rectal and left colonic cancers can improve lymph node yield, thus facilitating accurate tumor staging and thus better disease prognostication, but the survival benefit is not significant.

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Section: Discussionmentioning

confidence: 96%

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

Charan

Kapoor²,

Singhal³

et al. 2014

Indian J Surg

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“…There is a controversy, however, in the literature about whether the number of lymph nodes resected and evaluated impacts patient outcomes [29,30]. Further ambiguity exists even among the proponents of this quality metric regarding the exact number of lymph nodes needed to accurately stage a patient with colon cancer [5,[7][8][9][10][11][12][13][14][15][16][17][18]. Still, in the absence of a unique molecular signature of a colon tumor that dictates therapies and predicts a patient's course, the American College of Surgeons, ASCO, NCCN and others have adopted this as an indicator for quality assessment [24,26].…”

Section: Journal Of Surgical Oncologymentioning

confidence: 99%

“…There has been great discussion and variability in the literature about the number of nodes that need to be examined to stage patients with accuracy [5,[7][8][9][10][11][12][13]. In addition, a substantial body of literature suggests that the absolute number of lymph nodes removed, whether positive or negative, is independently correlated with survival [14,15].…”

Section: Introductionmentioning

confidence: 99%

Meeting the 12 lymph node (LN) benchmark in colon cancer

Rajput

Romanus

Weiser

et al. 2010

Journal of Surgical Oncology

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Background: Examining 12 LN in colon cancer has been suggested as a quality metric. The purpose of this study was to determine whether the 12 LN benchmark is achieved at NCCN centers compared to a US population-based sample. Methods: Patients with stage I-III disease resected at NCCN centers were identified from a prospective database (n ¼ 718) and were compared to 12,845 stage I-III patients diagnosed in a SEER region. Age, gender, location, stage, number of positive nodes were compared for NCCN and SEER data in regards to number of nodes evaluated. Multivariate logistic regression models were developed to identify factors associated with evaluating 12 LNs. Results: 92% of NCCN and 58% of SEER patients had 12 LN evaluated. For patients treated at NCCN centers, factors associated with not meeting the 12 LN target were left-sided tumors, stage I disease and BMI >30. Conclusions: 12 LN are almost always evaluated in NCCN patients. In contrast, this target is achieved in 58% of SEER patients. With longer follow-up of the NCCN cohort we will be able to link this quality metric to patterns of recurrence and survival and thereby better understand whether increasing the number of nodes evaluated is a priority for cancer control.

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“…3 Furthermore, a large prospective trial and several population-based studies reported that an increase in the number of lymph nodes sampled could improve survival through accurate staging and consequently tailored treatments. [4][5][6] A large body of research has documented that shortterm surgical complications and long-term survival are correlated with hospital volume. [7][8][9] Surgery-related mortality can be avoided if cancer surgeries are performed by high-volume hospitals.…”

Section: Introductionmentioning

confidence: 99%

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

Liu

Chou²,

Teng

et al. 2015

Cancer

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BACKGROUND:Patients with colorectal cancer (CRC) who undergo cancer surgeries with higher-volume providers may have better outcomes. The current debate focuses on whether it is hospital volume or surgeon volume that matters more. METHODS: The authors conducted a nationwide population-based study in Taiwan that enrolled all patients who underwent definitive surgery for newly diagnosed CRC between 2005 and 2011. All patients were divided into 4 quartiles according to hospital and surgeon volume. The main outcome was the 5-year mortality rate, which was analyzed using a frailty model for Cox regression. The authors also conducted fixed and random effects multivariate regression models to examine short-term outcomes and resource use, including operative mortality, hospital stay, emergency department visits within 30 days, and medical expenses. Analyses were adjusted for patient and provider characteristics. RESULTS: A total of 61,728 patients with CRC were included in the current study. The 5-year mortality rates were 38.7%, 32.8%, 32.0%, and 29.1% in descending order of hospital volume quartiles and were 41.4%, 34.1%, 29.8%, and 27.4% in descending order of surgeon volume quartiles. After adjustment for the individual and provider characteristics, surgeon volume, but not hospital volume, remained a significantly predictive factor of death (P<.001). In addition, those patients with CRC who underwent definitive surgeries performed by higher-volume surgeons had a relatively lower risk of operative mortality, shorter hospital length of stay, and lower medical expenses. CONCLUSIONS: Patients with CRC who underwent definitive surgery performed by higher-volume providers were found to have better outcomes. Surgeon volume may play a more important role than hospital volume. Cancer 2015;121:2782-90.

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Colon Cancer Survival Is Associated With Increasing Number of Lymph Nodes Analyzed: A Secondary Survey of Intergroup Trial INT-0089

Abstract: The number of lymph nodes analyzed for staging colon cancers is, itself, a prognostic variable on outcome. The impact of this variable is such that it may be an important variable to include in evaluating future trials.

Cited by 1,021 publications

References 16 publications

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

Meeting the 12 lymph node (LN) benchmark in colon cancer

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

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