Harvest of lymph nodes in colorectal cancer depends on demographic and clinical characteristics of the patients

Ng, Shu‐Kay; Lu, Cu-Tai; Pakneshan, Sahar; Leung, Melissa; Siu, Simon; Lam, Alfred King‐Yin

doi:10.1007/s00384-017-2927-0

Cited by 9 publications

(18 citation statements)

References 11 publications

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“…Xie and colleagues also add that the number of LNs examined and the number of positive LNs are an important prognostic factor: right-sided CRC with an increased number of LNs examined and adequate LN harvest at diagnosis is associated with decreased risk of LN positivity [ 24 ]. Ng and colleagues proposed a formula to quantify the number of LNs to be removed, which varies according to age, location, and size [ 25 ]. A systematic review of 17 studies from 1990 to 2006 that included 61,371 patients reported a positive association between a higher nodal harvest and long-term outcomes [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is broad variability in the definition of right and left colon (supplementary Fig. 10 ) [ 2 – 5 , 15 – 18 , 24 , 25 , 30 ]; we decided to follow the definition used by 5 recent studies [ 2 , 4 , 16 , 18 , 25 ] (including rectum and junction), considering the transverse colon separately. Nevertheless, comparability between studies is limited by the heterogeneity of definitions.…”

Section: Discussionmentioning

confidence: 99%

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Colon cancer survival differs from right side to left side and lymph node harvest number matter

et al. 2021

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Background Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. Methods All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. Results During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). Conclusions This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Colon cancer survival differs from right side to left side and lymph node harvest number matter

et al. 2021

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“…However, LNC varies depending on factors like age, tumour location, tumour stage, and lymph node size. [4][5][6] Furthermore, LNC decreases after neoadjuvant chemoradiotherapy (CRT) for which reason LNC might not be an adequate parameter for staging in rectal cancer after CRT. 7,8 Only 20% of cases who receive neoadjuvant therapy yield a LNC ≥ 12.…”

Section: Introductionmentioning

confidence: 99%

“…LNC has been considered to be a proxy of adequacy of both surgical lymphadenectomy and pathological examination of the specimen. However, LNC varies depending on factors like age, tumour location, tumour stage, and lymph node size 4–6 . Furthermore, LNC decreases after neoadjuvant chemoradiotherapy (CRT) for which reason LNC might not be an adequate parameter for staging in rectal cancer after CRT 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross‐sectional study

Detering

Meyer

Borstlap

et al. 2021

Journal of Surgical Oncology

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Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT). Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I-III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups.Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis.Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage.However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.

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“…28 In clinic, neoadjuvant chemoradiotherapy could compellingly reduce detected LNs, 47 a number of other patient-and tumor-related factors also play some roles in LNs yielding and assessment, such as the patient's gender, age, tumor grade, surgical type, body mass index, and so on. [48][49][50] Thereby, it would be regarded to have high risk factor if the number of LNs harvested per specimen were fewer than 12, according to the guideline of National Comprehensive Cancer Network (NCCN). 14,51,52 Other studies also claimed that more LNs are needed for staging, decision making, and prognosis predicting.…”

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confidence: 99%

<p>Application of Carbon Nanoparticles in Tracing Lymph Nodes and Locating Tumors in Colorectal Cancer: A Concise Review</p>

Liu

Tan

et al. 2020

IJN

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Background: Accurate lymph node (LN) staging has considerably prognostic and therapeutic value in patients with colorectal cancer (CRC). The purpose of this study is to evaluate the feasibility of applying carbon nanoparticles (CNPs) to track LN metastases in CRC. Methods: Two researchers independently screened publications in PubMed, EMBASE, Cochrane and Ovid MEDLINE databases. The keywords were (carbon nanoparticles OR activated carbon nanoparticles) AND (colon cancer OR rectal cancer OR colorectal cancer). Titles and abstracts of the articles were meticulously read to rule out potential publications. Next, full texts of the ultimately obtained eligible publications were retrieved and analyzed in detail. Results: The search produced 268 publications, and 140 abstracts were identified after a bibliographic review. Finally, 20 studies relevant to our subject were obtained; however, only 14 papers met our inclusion criteria and were included for final review. All studies included have compared the control group with carbon nanoparticles group (control group, defined as nontattooed group; and carbon nanoparticles group, defined as administering carbon nanoparticles during surgery) for their efficacy in intraoperative detecting and positioning. After analysis, appreciably less amount of bleeding (3/5 trials), shorter operation time (2/4 trials), and shorter time to detect lesions and dissect LNs (2/2 trials) were revealed in CNPs group compared to control group. Thirteen studies have recorded the numbers of the harvested LNs in both groups; meanwhile, CNPs group shows superiority to control group in LN retrieval as well (11/13 trials), which also could effectively aid in locating and harvesting more LNs with diameter below 5 mm. Conclusion: The tracing technique for CNPs is a safe and useful strategy both in localizing tumor and tracing LNs in CRC surgery. But there is still a need for more randomized controlled trials to further establish its contribution to patient survival.

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Harvest of lymph nodes in colorectal cancer depends on demographic and clinical characteristics of the patients

Cited by 9 publications

References 11 publications

Colon cancer survival differs from right side to left side and lymph node harvest number matter

Colon cancer survival differs from right side to left side and lymph node harvest number matter

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross‐sectional study

<p>Application of Carbon Nanoparticles in Tracing Lymph Nodes and Locating Tumors in Colorectal Cancer: A Concise Review</p>

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