Tumour stage and preoperative chemoradiotherapy influence the lymph node yield in Stages I–III rectal cancer: results from a prospective nationwide cohort study. (April 2014)

• Record Type: Journal Article
• Authors: Lykke, J.; Roikjær, O.; Jess, P.
• Is Part Of: Colorectal disease. Volume 16:Number 4(2014)
• Page Start: O144
• Page End: O149
• Publication Date: 2014-04
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12521
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" id="codi12521-abs-0001"> <title>Abstract</title> <sec id="codi12521-sec-0001" sec-type="section"> <title>Aim</title> <p>The study aimed to determine whether the lymph node yield (LNY) in rectal cancer is influenced by patient‐related and histopathological factors and the use of preoperative chemoradiotherapy (CRT).</p> </sec> <sec id="codi12521-sec-0002" sec-type="section"> <title>Method</title> <p>An analysis was carried out of the LNY in a nationwide Danish cohort of 7950 patients, treated by curative resection of Stage I–III rectal cancer during the period 2001–2011. The impact of year of diagnosis, age, gender, pathological stage of the tumour (pT‐stage) and preoperative CRT on LNY was analysed.</p> </sec> <sec id="codi12521-sec-0003" sec-type="section"> <title>Results</title> <p>Twenty‐nine per cent of the patients received preoperative CRT. The median LNY was 13 [interquartile range (IQR): 8–19]. A total of 43.4% of the patients had an LNY of < 12. The median LNY increased from 8 (IQR: 5–12) to 20 (IQR: 13–28) LNs over the years of the study period (<italic>P </italic><<italic> </italic>0.0001). Gender and body mass index (BMI) had no impact on the median LNY. Age had a minor impact, with a range of 12 (IQR: 8–18) to 13 (IQR: 9–20) (<italic>P </italic><<italic> </italic>0.0001). The LNY ranged from 9 (IQR: 6–14) to 16 (IQR: 10–26), according to pT‐stage (pT0–pT4) (<italic>P </italic><<italic> </italic>0.0001). Median LNY, according to preoperative CRT or no preoperative CRT, was 10 (IQR: 6–16) and 14 (IQR: 8–18), respectively (<italic>P </italic><<italic> </italic>0.0001). The percentages of patients with an LNY of < 12, according to preoperative CRT or no preoperative CRT, were 58.7% and 37.1%, respectively (<italic>P </italic><<italic> </italic>0.0001).</p> </sec> <sec id="codi12521-sec-0004" sec-type="section"> <title>Conclusion</title> <p>An increase in the LNY over the period of the study was observed, probably reflecting improved quality of surgery and histopathology. A minor significant reduction of LNY was found with increasing age of the patient. LNY was significantly related to pT‐stage and to the use of preoperative chemoradiotherapy. For these reasons the minimum harvest of 12 LNs as a surrogate marker for the oncological quality of surgery should be questioned.</p> </sec> </abstract>