What factors affect lymph node yield in surgery for rectal cancer?

Thorn, C.; Woodcock, N. P.; Scott, Nigel; Verbeke, Caroline S.; Scott, S. B.; Ambrose, N. S.

doi:10.1111/j.1463-1318.2004.00670.x

Cited by 96 publications

(77 citation statements)

References 20 publications

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“…Thorn found a higher number of lymph nodes in the mid rectal tumours [34]. Other significant positive association was found with involvement of the anterior quadrant, intravascular and perineural invasion, positive high tie lymph node, high Duke's and pT stages and poor response to neoadjuvent CRT as defined by Mandar, these finding are in agreement with some studies [12,20] but not with others [34,35]. Other histological features as the percentage of tumour load and tumour necrosis had a positive effect of the lymph node number while tumour fibrosis has a significant negative impact.…”

Section: Discussionmentioning

confidence: 91%

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Elsheikh¹,

M²

2016

J Adenocarcinoma

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Introduction: Total lymph node (TLN) count is an important qualifier of cancer evaluation and extensive nodal resection has been associated with lower rates of cancer recurrence; allows for more accurate cancer staging and improved survival following resection for rectal cancer. Aim:To examine the adequacy of lymph node sampling in rectal cancer and the influence of the clinicopathological factors and treatment modalities on the total lymph node yield.Methods: This is a retrospective study includes 409 cases of rectal cancer treated by surgical intervention only (126 cases), or surgery after short or long course chemotherapy (75 and 208 cases respectively).Results: TLN count range from (2-50, mean 12.38). Twelve lymph nodes were found in 49.4% of the specimens with or without neoadjuvent chemo radiatherapy (CRT). Patient treated with surgery only have a significant high total LN yield (mean is 15.53) in comparison with (12.99 and 10.25 for short course CRT and long course CRT respectively, P value <0.001). The number of lymph nodes was significantly correlated with the modality of treatment, anterior quadrant involvement, vascular and perineural invasion, pathological staging, Duke's and Mandard staging. On multivariate only perineural invasion, high tie lymph node involvement, Dukes stage, and tumour load were found to be the main predictors of the number of lymph node yield. Conclusion:The neoadjuvent CRT has a significant effect on the adequacy of lymph node sampling and a negative impact on the lymph nodes retrieved. This negative effect was more prominent with the long term rather than the short term CRT. This should be taken in consideration at the N staging of the tumour to avoid down-staging.

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Section: Discussionmentioning

confidence: 91%

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Elsheikh¹,

M²

2016

J Adenocarcinoma

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“…Indeed, the LNR was significant both in patients with more than 12 LNs as well as in patients with less than 12 LNs examined. Although the harvesting of more than 12 LNs is recommended for proper staging, the number of LNs that can be harvested decreases in rectal cancer patients who have undergone PCRT [16,18] . Therefore, it is questionable whether the same absolute numberbased staging system should be applied to all patients, including those with less than 12 retrieved LNs or patients who have been treated with PCRT.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, while a correlation between lymph node metastasis and poor oncologic outcome in patients treated with PCRT and radical resection has been suggested, the value of the LNR after PCRT remains controversial [14,15] . PCRT has been shown to result in a significant decrease in both the size and number of LNs available for examination after resection [16][17][18][19][20] . Consequently, the number of LNs examined could be below the recommended number in patients with rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Park¹,

Yu²,

Lim³

et al. 2015

WJG

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AIM:To evaluate the predictive value of the lymph node (LN) ratio (LNR, number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy (PCRT). The cut-off LNR was determined based on the pN1 vs pN2 when the recommended number of LNs was harvested. The 5-year recurrence-free survival (RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group. METHODS: RESULTS:Among patients with the same p/ypN stage, the 5-year RFS rate differed according to the LNR. In addition, the 5-year RFS rate was significantly different between pN and LNR groups in patients with No PCRT. In PCRT group, however, only LNR was associated with prognosis. On multivariate analysis, both pN and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group. In the PCRT group, only LNR category was found to be associated with RFS (HR = 2.36, 95%CI: 1.31-3.84, and P = 0.001). CONCLUSION:The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT. Current pN categories could not discriminate between prognostic groups of RFS after PCRT. Core tip: The number of metastatic lymph node might show different prognosis according to the number of examined lymph node. Retrieved number of lymph node after preoperative chemoradiotherapy (PCRT) has been known fewer than those without PCRT. However, number of metastatic lymph nodes used in pathologic staging was same between patients treated with PCRT and those without PCRT. The present study suggests the metastatic lymph node ratio would be useful prognostic indicator and it is more prominent in patients treated with PCRT.Park IJ, Yu CS, Lim SB, Yoon YS, Kim CW, Kim TW, Kim JH, Kim JC. Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy.

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“…According to current TNM staging system, at least 12 LNs are needed for accurate nodal staging. Many factors influence the number of lymph nodes retrieved, including tumor (size, stage) (Baxter et al, 2005), and the patient (age, sex) (Thorn et al, 2004;Gao et al, 2013), and neoadjuvant CRT (Rullier et al, 2008;Doll et al, 2009;Wang et al, 2009). Recent studies demonstrated that the total number of retrieved LNs was decreased due to preoperative chemoradiation, probably because of lymph node atrophy, fibrosis and lymphocyte depletion caused by radiotherapy or/and chemotherapy, and the number of harvested LNs was frequently less than12, despite the maintenance of vigorous surgical standards (Rullier et al, 2008;Doll et al, 2009;Wang et al, 2009;Lee et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Ratio is an Independent Prognostic Factor in Node Positive Rectal Cancer Patients Treated with Preoperative Chemoradiotherapy Followed by Curative Resection

Zeng

Zhou²,

Wang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The lymph node ratio (LNR) has been shown to be an important prognostic factor for colorectal cancer. However, studies focusing on the prognostic impact of LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) followed by curative resection have been limited. The aim of this study was to investigate LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy harvested LNs, and as well as in those ≥12 harvested LNs (p<0.05). In addition, LNR had a prognostic impact on both OS and DFS in patients with N1 staging (p<0.001). Conclusions: LNR is an independent prognostic factor in ypN-positive rectal cancer patients, both in patients with <12 harvested LNs, and as well as in those ≥12 harvested LNs. LNR provides better prognostic value than pN staging. Therefore, it should be used as an additional prognostic indicator in ypN-positive rectal cancer patients.

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What factors affect lymph node yield in surgery for rectal cancer?

Cited by 96 publications

References 20 publications

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Factors Influence Lymph Node Retrieval after Resection for Rectal Cancer

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy

Lymph Node Ratio is an Independent Prognostic Factor in Node Positive Rectal Cancer Patients Treated with Preoperative Chemoradiotherapy Followed by Curative Resection

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