Does the body mass index impact lymph node yield for colorectal cancer resection, and does operative approach influence this: a review of bi‐national colorectal cancer audit database

Abstract

Background Operating on an obese patient is technically more challenging. This study aimed to determine whether there was any correlation between lymph node (LN) harvesting and patient's BMI, and how the operative approach influences this. Methods A retrospective analysis of the bi‐national colorectal cancer audit (BCCA) database from 2008 to 2018 was performed. Results In the analysis of the correlation between operative approach and number of lymph nodes, data on 22 963 patients were analyzed. The operative approach did not lead to a significant difference in the number of lymph nodes yielded, except for proctocolectomy and low anterior resection where laparoscopic approach yielded greater lymph nodes than open approach. Linear regression of BMI and number of lymph nodes harvested for each operation based on 3986 patients showed that BMI largely does not impact the lymph node yield. The exception was open left hemicolectomy/sigmoid colectomy and laparoscopic high anterior resection, where a unit increase in BMI led to a reduction in the number of lymph nodes harvested. However, the regression coefficient and reduction in number of lymph nodes were low (r2 = 0.11, r2 = 0.0108 and 0.41, 0.18 lymph nodes). Conclusion In colorectal cancer operations, the number of lymph nodes removed is largely not impacted by the patient's body mass index, regardless of which operative approach is taken.

Short-Term Outcomes of Laparoscopic-Assisted Colectomy versus Open Colectomy in Patients with Colonic Carcinoma: A Prospective Randomized Study

“…In the present work, we assessed the efficacy of LAC in attaining the proper resection of the lymph nodes (LNs) affected in the vascular pedicle of the colon. We did not observe statistically significant differences between the groups concerning the number of LNs affected, which is in line with the study by Cheong et al 9 reported that in colonic cancer resections the LN harvested did not vary greatly between different operative approaches for each of the operations either LAC or OC, which is in line with the study by Balducci et al 10 However, Douaiher et al 11 reported that laparoscopic colonic resections were 1.5 to 2.5 times more likely to attain adequate LN resection compared to OC whoever several non-modifiable patient and tumer related factors may render adequate LN harvested challenging also. Ringressi et al highighted that the oncological effectiveness of LAC compared with OG as assesed by the same number of retrieved/examined LNs in the two study groups.…”

“…Curative surgical resection is the backbone of the treatment for colonic carcinoma. 7 Since the first description of LAC procedure, numerous studies [1][2][3][4][5][6][7][8][9][10][11][12] have demonstrated that, as compared to OC, LAC resections are associated with lower levels of pain, quicker recovery, and non-inferior oncological results. Although laparoscopic colorectal surgery has grown in popularity in recent years, numerous international surveys [13][14][15][16][17][18][19] have revealed that it is still mostly underutilised, with significant variations among centres.…”

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

“…Some studies found that fewer LNs were obtained from patients with high BMI than those with normal BMI 26 30. This may be attributed to the increase in the complexity of colorectal surgery in patients with more adipose tissue in the mesentery, resulting in lower LN retrieval 30 71. The results of the meta-analysis showed that BMI was not significantly associated with the number of retrieved LNs, which needs additional studies for confirmation.…”