Prognostic impact of the number of resected lymph node on survival in Colorectal Cancer

Abstract

Introduction Colorectal Cancer (CRC) is the third most common cancer and the second leading cause of death in Western countries. In Portugal, in the North, emerges as the second most common cancer. The presence of lymph node metastasis is an important predictor of overall and disease-free survival and several studies recommend the evaluation of at least 12–14 regional lymph nodes, as it contributes to improve cancer staging and patient outcomes. Aims Epidemiological characterization of the studied population and identify a possible relationship between the number of lymph nodes evaluated in the surgical specimen and survival. Methods We preceded to the study of 1065 CCR patients, submitted to surgical resection between 1 January 2000 and 31 August 2012, in Braga Hospital. Discussion/Conclusion The results of the epidemiological characterization of this population are coincident with those described in the literature. It was observed a significant correlation between age, tumor size, serosal invasion, differentiation, tumor penetration, venous and lymphatic invasion, metastasis, TNM stage and the number of lymph nodes evaluated. However, we did not observe a statistically significant correlation between patient survival and number of lymph nodes evaluated (p > 0.05). A possible explanation is the practice of oncologists, addressing patients with less than 12 nodes identified in the surgical specimen as “N-positive” and undergoing adjuvant therapy. A better harvest and careful analysis of lymph nodes would lead to more accurate staging, avoiding overtreatment and side effects associated, and allow better economic management of hospital resources, in real N0 patients.

Laparoscopic versus open transverse‐incision right hemicolectomy: a retrospective comparison study

“…The median number of lymph nodes harvested was higher in the laparoscopic group (25.6 versus 18.6 lymph nodes), but no significant difference in overall survival between groups was detected. At present, guidelines recommend a minimum of 12 lymph nodes harvested as the standard of care for colorectal cancer; however, it is still unclear if a higher number of removed lymph nodes may improve survival . Operating time was significantly higher in the laparoscopic group compared with the open group (182 ± 38.8 versus 105 ± 29 min).…”

“…At present, guidelines recommend a minimum of 12 lymph nodes harvested as the standard of care for colorectal cancer; however, it is still unclear if a higher number of removed lymph nodes may improve survival. [12][13][14] Operating time was significantly higher in the laparoscopic group compared with the open group (182 AE 38.8 versus 105 AE 29 min). Long-term occurrence of incisional hernias was significantly higher in the laparoscopic group (12 versus 0 cases); however, the vast majority of patients with incisional hernia were asymptomatic, with only one patient requiring surgical repair.…”

Visceral obesity is not correlated with lymph node metastases nor Colorectal cancer survival

“…The cut-off point for MLR was set at 18%; patients were then stratified into MLR = 0%, MLR < 18%, and MLR ≥ 18%. 3,12,13…”

“…1 In Northern Portugal, it is the second most common neoplasm, with an incidence rate of 41.6%; in the district of Braga, the incidence is 34%. 2,3 CRC stage at diagnosis is the main determinant of survival and the main predictor of mortality. 3,4 The TNM system is the most widely used staging system 3 ; the presence of ganglion metastasis is a determining factor for the indication of adjuvant chemotherapy and an important predictor of global and disease-free survival 3,5 Despite the lack of consensus, the literature presents an increasing number of studies correlating obesity with CRC, namely presentation in more advanced stages, carcinoembryonic antigen (CEA) level, morbidity and mortality rates, and hospitalization time.…”

“…2,3 CRC stage at diagnosis is the main determinant of survival and the main predictor of mortality. 3,4 The TNM system is the most widely used staging system 3 ; the presence of ganglion metastasis is a determining factor for the indication of adjuvant chemotherapy and an important predictor of global and disease-free survival 3,5 Despite the lack of consensus, the literature presents an increasing number of studies correlating obesity with CRC, namely presentation in more advanced stages, carcinoembryonic antigen (CEA) level, morbidity and mortality rates, and hospitalization time. [6][7][8][9][10] Neumann et al 7 reported that obesity in patients with CRC can lead to the formation of adenomatous polyps, and for each increment of one unit in the body mass index (BMI) above 30 kg/m 2 , there will be a 1% increase in the frequency with which these CRC precursor lesions are found.…”