Colorectal adenocarcinoma:

Hernánz, Fernando; Revuelta, S.; Redondo, Carlos; Madrazo, C. Fernandez; Diego, Julio Castillo; Gómez-Fleitas, Manuel

doi:10.1007/bf02053600

Cited by 115 publications

(21 citation statements)

References 8 publications

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“…Specifically, an adequate nodal harvest is more common in right colon lesions, non-emergent surgery, and higher stage lesions [30,35,36]. We identified a modest association between previous cancer history and lower rate of adequate nodal harvest, a finding not reported previously.…”

Section: Discussionsupporting

confidence: 43%

The impact of audit and feedback on nodal harvest in colorectal cancer

Porter

Urquhart

et al. 2011

BMC Cancer

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BackgroundAdequate nodal harvest (≥ 12 lymph nodes) in colorectal cancer has been shown to optimize staging and proposed as a quality indicator of colorectal cancer care. An audit within a single health district in Nova Scotia, Canada presented and published in 2002, revealed that adequate nodal harvest occurred in only 22% of patients. The goal of this current study was to identify factors associated with adequate nodal harvest, and specifically to examine the impact of the audit and feedback strategy on nodal harvest.MethodsThis population-based study included all patients undergoing resection for primary colorectal cancer in Nova Scotia, Canada, from 01 January 2001 to 31 December 2005. Linkage of the provincial cancer registry with other databases (hospital discharge, physician claims data, and national census data) provided clinicodemographic, diagnostic, and treatment-event data. Factors associated with adequate nodal harvest were examined using multivariate logistic regression. The specific interaction between year and health district was examined to identify any potential effect of dissemination of the previously-performed audit.ResultsAmong the 2,322 patients, the median nodal harvest was 8; overall, 719 (31%) had an adequate nodal harvest. On multivariate analysis, audited health district (p < 0.0001), year (p < 0.0001), younger age (p < 0.0001), non-emergent surgery (p < 0.0001), more advanced stage (p = 0.008), and previous cancer history (p = 0.03) were associated with an increased likelihood of an adequate nodal harvest. Interaction between year and audited health district was identified (p = 0.006) such that the increase in adequate nodal harvest over time was significantly greater in the audited health district.ConclusionsImprovements in colorectal cancer nodal harvest did occur over time. A published audit demonstrating suboptimal nodal harvest appeared to be an effective knowledge translation tool, though more so for the audited health district, suggesting a potentially beneficial effect of audit and feedback strategies.

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Section: Discussionsupporting

confidence: 43%

The impact of audit and feedback on nodal harvest in colorectal cancer

Porter

Urquhart

et al. 2011

BMC Cancer

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“…The probability increased to 99 percent if 10 lymph nodes were examined. The authors concluded that 6 lymph nodes provided an accurate assessment of the presence of nodal metastasis and an optimal Dukes' B classification [5]. Goldstein et al and Maurel et al showed that the probability of correctly classifying a colorectal tumor as node positive increased with the number of examined lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

The optimal number of lymph nodes examined in stage II colorectal cancer and its impact of on outcomes

2010

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BackgroundLymph node status is the most important prognostic factor for colorectal cancer. The number of lymph nodes that should be histologically examined has been controversial. The aims of this study were to assess the impact of the number of lymph nodes examined on survival of patients with stage II colorectal cancer and to determine the optimal number of lymph nodes that should be examined.MethodsThe study included 664 patients who underwent resection for stage II colorectal cancer. The clinical and histopathologic data of the patients were prospectively collected and analyzed.ResultsThe median number of lymph nodes examined was 12 (range: 1 to 58). The 5-year disease free survival rate was significantly higher for patients with 12 or more lymph nodes examined compared to those with less than 12 lymph nodes examined. The significant difference in 5-year disease free survival persisted if the dividing number increased progressively from 12 to 23. However, the difference in survival was most significant (lowest p value and highest hazard ratio) for the number 21. The 5-year disease free survival of patients with 21 or more lymph nodes examined was 80% whereas that of patients with less than 21 lymph nodes examined was 60% (p = 0.001, hazard ratio 2.08). Multivariate analysis showed that 21 or more lymph nodes examined was a factor that independently influenced survival. The 5-year disease free survival also increased progressively with the number of lymph node examined up to the number 21. After the number 21, the survival rate did not increase further. It was likely that 21 was the optimal number, at and above which the chance of lymph node metastasis was minimal.ConclusionsThe number of lymph nodes examined in colorectal cancer specimen significantly influences survival. It is recommended that at least 21 lymph nodes should be examined for accurate diagnosis of stage II colorectal cancer.

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“…Literature not clearly indicates how many nodes should be examined to accurately predict lymph node status [6–8, 23, 24]. One study showed that a colon specimen usually contains about 50 lymph nodes and that more than 70% of the lymph nodes containing metastases are smaller than 5 mm [9].…”

Section: Discussionmentioning

confidence: 99%

The sentinel node procedure in colon carcinoma: a multi-centre study in The Netherlands

Kelder

Braat

Karrenbeld

et al. 2007

Int J Colorectal Dis

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BackgroundLymph node status is the most important predictive factor in colorectal carcinoma. Recurrences occur in 20% of the patients without lymph node metastases. The sentinel lymph node (SLN) biopsy is a tool to facilitate identification of micrometastatic disease and aberrant lymphatic drainage. We studied the feasibility of in vivo SLN detection in a multi-centre setting and evaluated nodal micro-staging using immunohistochemistry (IHC).Materials and methodsSub-serosal injection with Patent Blue dye was used in the SLN procedure in 69 patients operated for localized colon cancer in six Dutch hospitals. Each SLN was examined with routine haematoxylin–eosin staining. In tumour-negative SLNs, we performed CK7/8 or 18 IHC.ResultsThe procedure was successful in 67 of 69 patients (97%). The SLN was negative in 43 patients. In three cases, it was false negative, resulting in a negative predictive value of 93% and an accuracy of 96%. In 24 of 27 patients with lymph node metastases in a successful SLN procedure, the SLN was positive (sensitivity 89%). In 15 patients, the SLN was the only positive node (21%). In nine patients, we only found micrometastases or isolated tumour cells, resulting in 18% upstaging. Aberrant lymphatic drainage was seen in three patients (4%).ConclusionThe SLN procedure in localized colon carcinoma is reliable in a multi-centre setting. It is helpful to identify patients who would be classified as stage II with conventional staging (18%) and who might benefit from adjuvant treatment.

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Colorectal adenocarcinoma:

Abstract: We must provide the pathologist with a minimum of six examined lymph nodes per surgical specimen for an optimal Dukes B assessment.

Cited by 115 publications

References 8 publications

The impact of audit and feedback on nodal harvest in colorectal cancer

The impact of audit and feedback on nodal harvest in colorectal cancer

The optimal number of lymph nodes examined in stage II colorectal cancer and its impact of on outcomes

The sentinel node procedure in colon carcinoma: a multi-centre study in The Netherlands

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