Factors affecting the number of lymph nodes retrieved after colo-rectal cancer surgery: A prospective single-centre study. Issue 1 (February 2020)

• Record Type: Journal Article
• Authors: Tonini, Valeria; Birindelli, Arianna; Bianchini, Stefania; Cervellera, Maurizio; Bacchi Reggiani, Maria Letizia; Wheeler, James; Di Saverio, Salomone
• Is Part Of: Surgeon. Volume 18:Issue 1(2020)
• Page Start: 31
• Page End: 36
• Publication Date: 2020-02
• Subjects: Lymphadenectomy -- Colorectal -- Cancer -- CME -- Prognostic factors -- Cancer staging -- Adequacy of lymphadenectomy -- Colorectal cancer surgery -- Colectomy -- Surgical oncology -- Colorectal malignancy; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2019.05.002
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Background: The number of harvested lymph nodes (LNs) in colorectal cancer surgery relates to oncologic radicality and accuracy of staging. In addition, it affects the choice of adjuvant therapy, as well as prognosis. The American Joint Committee on Cancer defines at least 12 LNs harvested as adequate in colorectal cancer resections. Despite the importance of the topic, even in high-volume colorectal centres the rate of adequacy never reaches 100%. The aim of this study was to identify factors that affect the number of harvested LNs in oncologic colorectal surgery. Materials and methods: We prospectively collected all consecutive patients who underwent colorectal cancer resection from January 1st 2013 to December 31st 2017 at Emergency Surgery Unit St Orsola University Hospital of Bologna. Results: Six hundred and forty-three consecutive patients (382 elective, 261 emergency) met the study inclusion criteria. Emergency surgery and laparoscopic approach did not have a significant influence on the number of harvested LNs. The adequacy of lymphadenectomy was negatively affected by age >80 (OR 3.47, p < 0.001), ASA score ≥3 (OR 3.48, p < 0.001), Hartmann's or rectal resection (OR 3.6, p < 0.001) and R1–R2 resection margins (OR 3.9, p = 0.006), while it was positively affected by T-status ≥3 (OR 0.33 p < 0.001). Conclusion: Both the surgical technique and procedure regimen did not affect the number of lymphnodes retrieved. Age >80 and ASA score ≥3 and Hartmann's procedure or rectal resection showed to be risk factors related to inadequate lymphadenectomy in colorectal cancer surgery. Highlights: AJCC defines at least 12 LNs harvested as adequate in CRC resections and this number is related to oncologic radicality and accuracy of staging. The adequacy of lymph-node retrieval in emergency and elective surgery is comparable, as well as in laparoscopic and open surgery. Age >80, ASA score >3 and Hartmann's or rectal resection are risk factors for inadequate lymph node retrieval. Unless suboptimal lymphadenectomy due to patients' age or comorbidities, awareness among surgeons and pathologists about its accuracy is needed. The correct number of LNs to be examined is not the minimum threshold (≥12), but the whole number of LNs retrievable from the entire specimen.