Hospital‐to‐hospital variation in lymph node detection after colorectal resection

Miller, Eric A.; Woosley, John T.; Martin, Christopher F.; Sandler, Robert S.

doi:10.1002/cncr.20478

Cited by 80 publications

(41 citation statements)

References 66 publications

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“…Although we have no direct evidence showing the contribution of (2), it is difficult to find other speculation other than differentiated precision of pathological examination for the variation in the NLNR by institute (23). It remains unknown why age and gender were related to the NLNR as shown not only in the present but also in other studies (2,3,10).…”

Section: Discussionmentioning

confidence: 41%

“…It remains unknown why age and gender were related to the NLNR as shown not only in the present but also in other studies (2,3,10). Studies have reported that the NLNR is influenced also by inflammation (21), diverticulum (21) and obesity (19,23,24). In this manner, the NLNR is determined most prominently by the extent of surgery, but is influenced to some degree by other factors.…”

Section: Discussionmentioning

confidence: 58%

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Number of Lymph Nodes Retrieved is an Important Determinant of Survival of Patients with Stage II and Stage III Colorectal Cancer

Kotake

Honjo²,

Sugihara³

et al. 2011

Japanese Journal of Clinical Oncology

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Objective: The number of lymph nodes retrieved is recognized to be a prognostic factor of Stage II colorectal cancer. However, the prognostic significance of the number of lymph nodes retrieved in Stage III colorectal cancer remains controversial. Methods: The relationship between the number of lymph nodes retrieved and clinical and pathological factors, and significance of the number of lymph nodes retrieved for prognosis of Stage II and III colorectal cancer were investigated. A total of 16 865 patients with T3/T4 colorectal cancer who had R0 resection were analysed. Results: The arithmetic mean of the number of lymph nodes retrieved of all cases was 20.0. The number of lymph nodes retrieved were varied according to several clinical and pathological variables with significant difference, and the greater difference was observed in scope of nodal dissection. Survival of Stages II and III was significantly associated with the number of lymph nodes retrieved. Five-year overall survival of the patients with 9 of the number of lymph nodes retrieved and those with .27 differed by 6.4% for Stage II colon cancer, 8.8% for Stage III colon cancer, 12.5% for Stage II rectal cancer and 10.6% for Stage III rectal cancer. With one increase in the number of lymph nodes retrieved, the mortality risk was decreased by 2.1% for Stage II and by 0.8% for Stage III, respectively. The cut-off point of the number of lymph nodes retrieved was not obtained. Conclusions: The number of lymph nodes retrieved was shown to be an important prognostic variable not only in Stage II but also in Stage III colorectal cancer, and it was most prominently determined by the scope of nodal dissection. A cut-off value for the number of lymph nodes retrieved was not found, and it is necessary to carry out appropriate nodal dissection and examine as many lymph nodes as possible.

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 58%

Number of Lymph Nodes Retrieved is an Important Determinant of Survival of Patients with Stage II and Stage III Colorectal Cancer

Kotake

Honjo²,

Sugihara³

et al. 2011

Japanese Journal of Clinical Oncology

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“…[20][21][22] In addition, for colorectal cancer, it has been demonstrated that the number of assessed lymph nodes increases as surgical and hospital volumes increase. [22][23][24][25][26] The exact contribution of each of these factors to the improvement in survival with increasing TLN or whether TLN is a surrogate of overall quality as it pertains to postoperative care, follow-up, or subsequent therapy could not be determined in the current study. Irrespective of the reasons for these differences, patients with more TLNs assessed have improved survival, and this finding has important implications for clinical prognostication.…”

Section: Lymph Nodes In Small Bowel Carcinoma/overman Et Almentioning

confidence: 99%

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Overman

Wolff

et al. 2010

Cancer

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BACKGROUND:The presence of distant metastases and the completeness of resection are important prognostic factors in patients with small bowel adenocarcinoma (SBA); however, the influence of lymph node metastasis on patient outcome has not been well characterized. The objective of the current study was to evaluate the impact of the number of positive and negative lymph nodes on survival after curative resection. METHODS: Patients who had SBA diagnosed between 1988 and 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox proportional hazards regression analyses were performed after adjusting for age, sex, race, tumor stage, tumor grade, and primary site. Five-year disease-specific survival (DSS) was determined, all patients were categorized according to the total lymph nodes (TLNs) assessed, and patients with stage III disease also were categorized according to the number of positive lymph nodes (PLNs) and the PLN-to-TLN ratio (the lymph node ratio [LNR]). RESULTS: In total, 1991 patients (n ¼ 1216 with stage I/II SBA and n ¼ 775 with stage III SBA) were analyzed. Survival depended on the TLNs assessed. The 5-year DSS rate for patients with stage II disease was associated with the TLNs assessed (44%, 69%, and 83% for 0 TLNs, 1-7 TLNs, and >7 TLNs, respectively). The 5-year DSS for patients with stage III disease was associated with the number of PLNs (58% and 37% for <3 PLNs and 3 PLNs, respectively). Among patients with stage III disease, the LNR was even more predictive of survival than stratification by the number of PLNs. CONCLUSIONS: Survival after surgical resection for stage I, II, and III SBA was associated with the TLNs assessed. Stratifying patients with stage III disease into those with <3 PLNs and 3 PLNs significantly improved prognostication. Cancer 2010;116:5374-82.

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“…The number of lymph nodes recovered from resection specimens is dependent on several factors. Surgical technique, surgery volume, and patient factors (e.g., age and anatomic variation) alter the actual number of nodes in a resection specimen (37,39,40), but the diligence and skill of the pathologist in identifying and harvesting lymph nodes in the specimen also are major factors (40). Because it has been shown that nodal metastasis in colorectal cancer is often found in small lymph nodes (<5 mm in diameter; refs.…”

Section: N Category Issuesmentioning

confidence: 99%

Optimal Pathologic Staging: Defining Stage II Disease

Compton

2007

Clinical Cancer Research

103

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Tumor stage remains the most important determinant of prognosis in colorectal cancer and is the basis of all authoritative patient management guidelines. The pathologic assessment of stage II disease is especially critical because it may help to identify patients at additional risk for whom surgery alone may not be curative. Accurate analysis of regional lymph nodes, extent of tumor penetration, and circumferential resection margins constitute the most crucial issues. For assignment of pN0, adequacy of the surgical resection and thoroughness of the lymph node harvest from the resection specimen are both essential. The minimum number of lymph nodes has been variably determined to be between 12 and 18 for assignment of pN0, but the confidence level increases with increasing numbers of nodes examined. The ability of exhaustive analysis of sentinel lymph nodes using special techniques to substitute for an exhaustive lymph node harvest and standard node examination has not been definitively shown. Although special techniques may facilitate the identification of minute amounts of tumor (i.e., isolated tumor cells) in regional lymph nodes, the prognostic significance of such findings remains unclear. Additional stageindependent pathologic features that have been validated as adverse prognostic factors include involvement by tumor of mural lymphovascular channels, venous vessels, or the surgical resection margin of the operative specimen and high tumor grade. The presence of these features may help to identify patients for whom surgery alone will not be curative and adjuvant therapies may be appropriate.

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Hospital‐to‐hospital variation in lymph node detection after colorectal resection

Cited by 80 publications

References 66 publications

Number of Lymph Nodes Retrieved is an Important Determinant of Survival of Patients with Stage II and Stage III Colorectal Cancer

Number of Lymph Nodes Retrieved is an Important Determinant of Survival of Patients with Stage II and Stage III Colorectal Cancer

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

Optimal Pathologic Staging: Defining Stage II Disease

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