The positive impact of surgical quality control on adequate lymph node harvest by standardized laparoscopic surgery and national quality assessment program in colorectal cancer

Unwarranted clinical variation in healthcare impacts access, productivity, performance, and outcomes. A strategy proposed for reducing unwarranted clinical variation is to ensure that population-based data describing the current state of health care services are available to clinicians and healthcare decision-makers. The objective of this study was to measure variation in colorectal cancer surgical treatment patterns and surgical quality in Manitoba and identify areas for improvement. This descriptive study included individuals aged 20 years or older who were diagnosed with invasive cancer (adenocarcinoma) of the colon or rectum between 1 January 2010 and 31 December 2014. Laparoscopic surgery was higher in colon cancer (24.1%) compared to rectal cancer (13.6%). For colon cancer, the percentage of laparoscopic surgery ranged from 12.9% to 29.2%, with significant differences by regional health authority (RHA) of surgery. In 86.1% of colon cancers, ≥12 lymph nodes were removed. In Manitoba, the negative circumferential resection margin for rectal cancers was 96.9%, and ranged from 96.0% to 100.0% between RHAs. The median time between first colonoscopy and resection was 40 days for individuals with colon cancer. This study showed that high-quality colorectal cancer surgery is being conducted in Manitoba along with some variation and gaps in quality. As a result of this work, a formal structure for ongoing measuring and reporting surgical quality has been established in Manitoba. Quality improvement initiatives have been implemented based on these findings and periodic assessments of colorectal cancer surgery quality will continue.

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Lymph Node Yield in Open vs. Laparoscopic Surgery for Colorectal Cancer: A Retrospective Observational Study

10.9734/bpi/nfmmr/v7/3312f ◽

2021 ◽

pp. 135-143

Author(s):

Ahmed Elamin Elsadig Abdalla

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Laparoscopic Surgery ◽

Observational Study ◽

Retrospective Observational Study ◽

Lymph Node Yield ◽

Node Yield

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Laparoscopic surgery for colorectal cancer with persistent descending mesocolon

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1734-1 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Yukiharu Hiyoshi ◽

Yuji Miyamoto ◽

Kojiro Eto ◽

Yohei Nagai ◽

Masaaki Iwatsuki ◽

...

Keyword(s):

Colorectal Cancer ◽

Blood Flow ◽

Lymph Node ◽

Laparoscopic Surgery ◽

Postoperative Complications ◽

Sigmoid Colon ◽

Lymph Node Dissection ◽

Node Dissection ◽

Marginal Artery ◽

Ir Imaging

Abstract Background Persistent descending mesocolon (PDM) is caused by the absence of fusion of the descending colon to the retroperitoneum. We herein report two colorectal cancer cases with PDM that were treated with laparoscopic surgery. Case presentation Case 1: a 50-year-old man with sigmoid colon cancer and synchronous liver metastasis. After neoadjuvant chemotherapy, he underwent laparoscopic sigmoidectomy with lymph node dissection cutting the root of the inferior mesenteric artery (IMA) and synchronous liver resection. He experienced postoperative stenosis of the reconstructed colon possibly due to an impaired arterial blood flow in the reconstructed colon. Case 2: a 77-year-old man with rectal cancer. Laparoscopic low anterior resection preserving the left colic artery (LCA) was performed. Intraoperative infrared ray (IR) imaging using indocyanine green (ICG) showed good blood flow of the reconstructed colon. He had no postoperative complications. In cases of PDM, the mesentery of the descending and sigmoid colon containing the LCA is often shortened, and the marginal artery of the reconstructed colon is located close to the root of the LCA. Lymph node dissection accompanied by cutting the LCA carries a risk of marginal artery injury. Therefore, we recommend lymph node dissection preserving the LCA in colorectal cancer patients with PDM in order to maintain the blood flow of the reconstructed colon. If the IMA and LCA absolutely need to be cut for complete lymph node dissection, the marginal artery should be clearly identified and preserved. In addition, intraoperative IR imaging is extremely useful for evaluating colonic perfusion and reducing the risk of anastomotic complications. Conclusion In colorectal cancer surgery in patients with PDM, surgeons should be aware of these tips for maintaining the blood flow of the reconstructed colon and thereby avoid postoperative complications caused by an impaired blood flow.

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Same Surgeon: Different Centre Equals Differing Lymph Node Harvest following Colorectal Cancer Resection

International Journal of Surgical Oncology ◽

10.1155/2011/406517 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

M. D. Evans ◽

S. Robinson ◽

S. Badiani ◽

A. Rees ◽

J. D. Stamatakis ◽

...

Keyword(s):

Colorectal Cancer ◽

Multivariate Analysis ◽

Lymph Node ◽

Surrogate Marker ◽

National Standards ◽

Case Mix ◽

Surgical Quality ◽

Cancer Resection ◽

Colorectal Cancer Resection ◽

Study Population

Introduction. The aim of this study was to examine the effect of surgeon relocation on lymph node (LN) retrieval in colorectal cancer (CRC) resection.Methods. The study population was 213 consecutive patients undergoing CRC resection by a single surgeon, at two units: unit one 110 operations (2002–2005) and unit two 103 (2005–2009). LN yields and case mix were compared.Results. Median LN harvests were significantly different between the two centres: unit 1: 13 nodes/patient and unit 2: 22 nodes/patient (). In unit one 42% of cases were LN positive and in unit two 48% (). There was no difference in case mix. Multivariate analysis identified unit () and pathologist () as independent predictors of harvest.Conclusions. A surgeon moving units can experience significantly different LN yield following CRC resection. Both units comply with national standards, but the “surgeon's results” at the two units appear to be pathologist dependent. This has implications for nodal harvest as a surrogate marker of surgical quality.

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Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma

Gastroenterology Research and Practice ◽

10.1155/2018/1985031 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Ameer Hamza ◽

Ramen Sakhi ◽

Sidrah Khawar ◽

Ahmed Alrajjal ◽

Jacob Edens ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Scientific Evidence ◽

Quality Standard ◽

Optimal Number ◽

Lymph Node Staging ◽

Lymph Node Count ◽

National Quality ◽

Node Count

As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.

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Impact of robotic-assisted approach on lymphadenectomy for colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.787 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 787-787

Author(s):

Reza Gamagami ◽

Paul Kozak ◽

Venkata R. Kakarla

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Laparoscopic Surgery ◽

Lymph Nodes ◽

Demographic Data ◽

Robotic Assisted ◽

Lymph Node Harvest ◽

Significant Difference ◽

The Mean ◽

The Impact

787 Background: In most recent years, robotic assisted laparoscopic surgery (RALS) has proven to be a viable alternative to laparoscopic and traditional open surgery for colorectal cancer. Obtaining the adequate number of lymph nodes is not only essential for accurate staging, but also impacts both prognosis and the need for adjuvant chemotherapy. To date, the efficacy of lymph node harvest for RALS is not well studied or established. The aim of our study is to analyze the impact of RALS on lymphadenectomy for colorectal cancer. Methods: We performed a retrospective review of patients who underwent curative resections for colorectal cancer over a five-year period at a single institution by a single surgeon. Resections were classified as right-sided, sigmoid, or rectal, and subdivided into robotic and non-robotic surgery groups. The demographic data and histopathology were obtained, with an emphasis on the number lymph nodes harvested (LNH) during resections. Emergencies and non-curative resections were excluded. Results: Between January 2010 and December 2015, 136 patients with colorectal cancer underwent curative resections. Sixty-four underwent right-sided resections (28 laparoscopic, 36 robotic). Twenty-five underwent sigmoid resections (11 laparoscopic, 14 robotic), and 47 underwent rectal resections (15 open, 32 robotic). There was no significant difference in age, sex, BMI and ASA scores between the cohorts examined. The mean number of LNH with RALS was significantly higher in all three groups (right-sided—24 vs. 15 ( p= .0001), sigmoid—16 vs. 12 ( p= .046), rectal—19 vs. 4 ( p= .0016)). There was no difference in the rate of adequate lymph node extraction for staging purpose, i.e., 12 lymph nodes in all three groups. Conclusions: Robotic-assisted laparoscopic surgery is associated with a statistically significant increase in lymph node harvest for right-sided, sigmoid and rectal resections for malignancy. Future studies with larger sample sizes are necessary to validate these findings.

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