Variability in the lymph node retrieval after resection of colon cancer

Abstract

The purpose of this study was to evaluate variations in the number of retrieved lymph nodes (LNs) over time and to determine the factors that influence the retrieval of <12 LNs during colon cancer resection.Patients with colon cancer who were surgically treated between 1997 and 2013 were identified from our institutional tumor registry. Patient, tumor, and pathologic variables were evaluated. Factors that influenced the retrieval of <12 LNs were evaluated using multivariate logistic regression modeling, including time effects.In total, 6967 patients were identified. The median patient age was 61 years (interquartile range [IQR] = 45–79 years) and 58.4% of these patients were male. The median number of LNs retrieved was 21 (IQR = 14–29), which increased from 14 (IQR = 11–27) in 1997 to 26 (IQR = 19–34) in 2013. The proportion of patients with ≥12 retrieved LNs increased from 72% in 1997 to 98.8% in 2013 (P < 0.00001). This corresponded to the more recent emphasis on a multidisciplinary approach to adequate LN evaluation. The number of retrieved LNs was also found to be associated with age, sex, tumor location, T stage, and operative year. Tumor location and T stage influenced the number of retrieved LNs, irrespective of the operative year (P < 0.05). Factors including a tumor location in the sigmoid/left colon, old age, open resection, earlier operative year, and early T stage were more likely to be associated with <12 recovered LNs (P < 0.5; chi-squared test) (P < 0.001).The total number of retrieved LNs may be influenced by tumor location and T stage of a colon cancer, irrespective of the year of surgery. LN retrieval after colon cancer resection has increased in recent years due to a better awareness of its importance and the use of multidisciplinary approaches.

Laparoscopic colectomies associated with decreased retrieval of 12 or more lymph nodes compared to open in elective colon cancer surgery

“…The proportion of patients with <12 excised LNs were higher in the early-stage of colorectal cancer. However, the process of LN examination during the curative resection of colon cancer has improved [4]. By drawing data from the NSQIP, we were limited to the variables available for analysis, and, therefore, confounding variables such as age, cancer stage, operative approach, location of cancer in the colon, etc., that may affect the usefulness in MOABP in LNs retrieval were not analysed.…”

“…An excision of 12 or more LNs is considered as the current standard of treatment in colorectal carcinomas [2,4]. The National Comprehensive Cancer Network (NCCN) and the College of American Pathologists, and the American Joint Committee on Cancer (AJCC) suggest a minimum of 12 LNs to establish the colorectal staging [19].…”

“…The probability of harvesting more LNs has been predicted by a more contemporary year of operation, increased tumour stage, higher tumour grade, younger patients and non-Caucasian ethnicity [2]. Harvesting fewer LNs has been associated with the year of operation, early tumour stage, elder patients and the operation approach [4]. Although in recent years, the proportion of patients having at least 12 LNs examined has increased significantly, there is still a need to increase the percentage of adequate LN retrieval (only 80% in 2011) [2,4].…”

“…Harvesting fewer LNs has been associated with the year of operation, early tumour stage, elder patients and the operation approach [4]. Although in recent years, the proportion of patients having at least 12 LNs examined has increased significantly, there is still a need to increase the percentage of adequate LN retrieval (only 80% in 2011) [2,4].…”

“…Most studies achieved greater than 12 LNs using various procedures, such as laparoscopic complete mesocolic excision (CME), open CME, CME with complete vascular ligation, laparoscopic radical LN dissection including non-regional LNs, robotic surgery, intra-and extracorporeal laparoscopic surgery, single-and multi-port laparoscopic surgery, 2D versus 3D laparoscopic surgery and even a multidisciplinary approach [4][5][6][7][8][9][10][11][12][13][14][15].…”