Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

Abstract

Objective: The lymph node number as benchmark in oncologic operations depends on the patient’s anatomy, surgeon’s skill and pathologist’s accuracy. The influence of the pathologist is barely evaluated. Methods: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. Results: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. Conclusion: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards.

Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes

“…For comparison, the learning curve for PALND using traditional laparoscopic approach involved 100 operations in the study of Altgassen et al 16 Direct comparisons regarding the number of lymph nodes harvested between different studies are problematic because of differences in the ways of counting the nodes. 17 However, our results are in general agreement with previous literature. The median numbers of para-aortic and pelvic lymph nodes harvested in our study were 12 and 23, respectively.…”

Laparoscopic pelvic lymphadenectomy: experience of a Gynaecological Cancer Centre in the UK

“…Our mean nodal yield of 10 (1-29) was slightly less in comparison with some other series with nodal yields of 21.9 and 18 nodes per patient [2,5] respectively. This could be accounted for by a lack of standardisation of histology reporting between different Centres [16]. The possibility of suboptimal surgical treatment could be considered.…”

High Variability in Lymph Node Counts Among an International Cohort of Pathologists: Questioning the Scientific Validity of Node Counts

“…Multiple studies have attempted to assess LNC variability and have demonstrated a variety of factors, including the patient's anatomy, tumor biology, experience of the gross examiner, and use of fat-clearing solutions. 6,[8][9][10][11][12] Although many of these studies also identify the pathologist as a significant source of variation, this has not been uniformly true. 13 By far, the least investigated aspect of LNC is the actual enumeration process of the pathologist during microscopic review; however, this is the time at which the LNC is determined.…”