The role of sentinel lymph node mapping in colon cancer: detection of micro-metastasis, effect on survival, and driver of a paradigm shift in extent of colon resection

Author(s):  
Sukamal Saha ◽  
Bekele Philimon ◽  
Malore Efeson ◽  
Abebe Helina ◽  
Mohamed Elgamal ◽  
...  
2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15000-e15000
Author(s):  
S. Saha ◽  
S. Sirop ◽  
A. Korant ◽  
B. Chakravarty ◽  
N. Krishnaiah ◽  
...  

e15000 Introduction: Sentinel Lymph Node Mapping (SLNM) in colon cancer (CCa) is shown to be successful, sensitive and accurate. We aimed to evaluate the survival of patients (pts) undergoing SLNM in addition to the standard colon resection, compare it to pts without SLNM and correlate it to the number of LN metastasis. Methods: Staging and survival analysis from our prospective database (gpA, 195 pts) were compared to the Surveillance, Epidemiology, and End Results (SEER) database (gpB, 126,484 pts) between 1996–2003. All pts had invasive CCa. GpA pts underwent SLNM plus complete resection. The minimum follow up (F/U) was 5 years. The primary outcome was cancer-specific survival. Exclusion criteria were stage IV disease, 2nd malignancy, or lost to F/U. Cancer specific survival of gpA was then analyzed according to the number of positive LNs. Results: In gpA (195 pts), SLNM was successful in 99.7%, of pts with a sensitivity, negative (-ve) predictive value, and false -ve rates of 86.3%, 91.7% and 14.6% respectively. In 15.1% of node +ve pts, the disease was upstaged because of micrometastasis (0.2–2mm). In gpA, 128 pts were included, of which 17(13.3%) lost to F/U as compared to 89,483 pts included in gpB, of which 47,168 (52.7%) lost to F/U. The average number of LNs examined per pt was 15 in gpA as compared to 12.4 in gpB (p=<0.0001). The 5 year-cancer specific survival of pts in gpA vs gpB was 100% vs 94.9% in stage I, 91.2% vs 83.5% in stage II and 81.8% vs 63% in stage III disease. For gpA pts, the 5 year cancer-specific survival decreased from 95.0% in node -ve disease to 92.8% when 1 LN was +ve, 83.3% when 2 LNs were +ve and 71.4% when 3 or more LNs were +ve (Table). Conclusions: A significant number of pts with CCa are being upstaged and the true node -ve disease is being identified when SLNM is performed at the time of surgery leading to improved survival as compared to conventional surgery. Our study showed that the number of LN metastasis is a predictor of cancer specific survival even after SLNM in CCa. [Table: see text] No significant financial relationships to disclose.


2011 ◽  
Vol 13 (11) ◽  
pp. 1249-1255 ◽  
Author(s):  
E. B. Rivet ◽  
M. G. Mutch ◽  
J. H. Ritter ◽  
A. A. Khan ◽  
J. S. Lewis ◽  
...  

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14046-e14046
Author(s):  
Sukamal Saha ◽  
Mohammed Nawaf Kanaan ◽  
Mohammad Mozayen ◽  
Philip Gafford ◽  
Mohammed Saifullah Shaik ◽  
...  

e14046 Background: Unlike other solid tumors, tumor size (TS) is not a part of the TNM staging system for colon cancer. Our goal is to correlate TS with TNM staging, nodal positivity (NP), and 5-year overall survival (OS) for patients (pts) with invasive colon cancer undergoing sentinel lymph node mapping (SLNM) vs. conventional surgery (CS). Methods: A retrospective review of 681 pts with invasive adenocarcinoma of the colon were reviewed and divided into two groups of pts (SLNM and CS). These groups were subdivided according to the size of the tumor in four groups (0-2, 2-4, 4-6 and more than 6 cm). 461 pts underwent SLNM between 1996-2010 compared to 220 pts who underwent CS between 1996-2006. The pathology reports reviewed for TS (the maximum diameter of the primary tumor), T staging, and NP. The OS was calculated from the social security database. Then all data was compared between both groups. Results: Pts with tumors <2cm were mainly T1+T2 (72%, 70%), whereas tumors >6 cm, majority of pts wereT3+T4 (94%, 85%). T1+T2 percentage consistently decreased as TS increased, and T3+T4 percentage was increasing consistently with increased TS (Table 1A). NP according to TS for SLNM pts were (16%, 53%, 56%, 48%) NP and for CS pts were (15%, 32%, 34%, 39%). In both groups, NP increased as TS increased compared to 0-2 cm group. The overall NP in both groups was 47% and 31% (Table 1B). OS for SLNM and CS pts were calculated in each group according to TS. Overall SLNM pts had better OS when compared to CS pts (65 %, 54%). Conclusions: Increasing TS was consistent with increasing T staging for both SLNM and CS pts. NP and OS were worse with increased TS for SLNM and CS pts. SLNM pts had higher NP and better outcome in OS when compared to CS pts, hence TS should be considered as a prognostic factor in pts with adenocarcinoma of the colon. [Table: see text] [Table: see text]


2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 546-546 ◽  
Author(s):  
Sukamal Saha ◽  
Mohammed Nawaf Kanaan ◽  
Mohammed Shaik ◽  
Benjamin Abadeer ◽  
Alpesh Korant ◽  
...  

546 Background: Unlike other solid tumors, tumor size (TS) is not a part of the TNM staging for colon cancer (CC). Our goal is to correlate TS with TNM staging, nodal positivity(NP), and 5-year overall survival (OS) for patients (pts) with invasive CC undergoing sentinel lymph node mapping (SLNM) vs. conventional surgery (CS). Methods: A retrospective review of 681 pts with invasive CC were reviewed and divided into two groups of pts (SLNM and CS). The pts in these two groups were subdivided according to the TS in four groups (0-2, 2-4, 4-6 and more than 6 cm). 461 pts underwent SLNM between 1996-2010 compared to 220 pts who underwent CS between 1996-2006. The pathology reports reviewed for TS (the maximum diameter of the primary tumor), T staging, and NP. The OS was calculated from the social security database and our hospital cancer registry. Then all data was compared between both groups. Results: Pts with TS <2cm were mainly T1+T2 (72%, 70%), whereas tumors >6 cm, majority of pts wereT3+T4 (94%, 85%). T1+T2 percentage consistently decreased as TS increased, and T3+T4 percentage was increasing consistently with increased TS (Table 1A). NP according to TS for SLNM pts were (16%, 53%, 56%, 48%) NP and for CS pts were (15%, 32%, 34%, 39%). In both groups, NP increased as TS increased compared to 0-2 cm group. The overall NP in both groups was 47% and 31% (Table 1B). OS for SLNM and CS pts were calculated in each group according to TS. Overall SLNM pts had better OS when compared to CS pts (65 %, 54%). Conclusions: Increasing TS was consistent with increasing T staging for both SLNM and CS pts. NP and OS were worse with increased TS for SLNM and CS pts. SLNM pts had higher NP and better outcome in OS when compared to CS pts, hence TS should be considered as a prognostic factor in pts with adenocarcinoma of the colon. [Table: see text]


2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 734-734
Author(s):  
Sabarina Ramanathan ◽  
Sukamal Saha ◽  
Suresh Mukkamala ◽  
Michael Hicks ◽  
Patrick Knight ◽  
...  

734 Background: Unlike in breast cancer or melanoma, resection during sentinel lymph node mapping (SLNM) in colon cancer (CCa) includes regional lymphadenectomy including SLNs and non SLNs. However, SLNM often identifies micrometastases which can be missed by conventional (Conv) surgery and pathologic examination. It is unknown whether this impacts survival or recurrence. Hence, a retrospective analysis was undertaken to study overall (OS) and disease -specific (DSS) survival between patients (pts) undergoing SLNM vs Conv surgery based on the number of +veLNs. Methods: SLNM was done by subserosal injection with blue dye followed by segmental resection including regional lymphadenectomy. All SLNs were ultrastaged and other nodes were examined by conv. methods with H&E. Results: There are 309 pts in SLNM (GpA) vs 499 pts in Conv surgery (GpB); with average no. of lymph nodes (LNs) and +ve LNs 17.3/1.6 vs 14.4/2.49 respectively. For GpA, success rate was 99.6% and the average no of SLN was 3. Of the pts in GpA vs GpB, 1+ve LN were found in 38% vs 27%, 2+ve LNs in 10% vs 16%, and > 2 LNs in 53% vs 57%, respectively. Comparing 5 years OS between GpA vs GpB, for 1+ve LN was 62.8% vs 52.38%, for 2 +ve LNs 72.7% vs 48.65% and for > 2 +ve LNs 35% vs 33.33%, respectively. Similarly, DSS for 1 +veLN was 54.4% vs 47.6%, 2+ve LNs 40% vs 40.54% and > 2+ve LNs, 30.4% vs 25.76%, respectively(Table1.). Conclusions: Compared to Conv surgery, SLNM identified higher no. of LNs per pt with high success rate. Five-year OS and DSS also are better in SLNM vs Conv surgery for all +ve LN gps. Hence, SLNM in CCa may have prognostic value. A larger multicenter trial needs to be done to validate such data. [Table: see text]


2012 ◽  
Vol 33 (8) ◽  
pp. 832-837 ◽  
Author(s):  
Robbert J. de Haas ◽  
Dennis A. Wicherts ◽  
Monique G.G. Hobbelink ◽  
Paul J. van Diest ◽  
Frank P. Vleggaar ◽  
...  

2001 ◽  
Vol 182 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Juan C Paramo ◽  
Janna Summerall ◽  
Christopher Wilson ◽  
Amadeo Cabral ◽  
Irvin Willis ◽  
...  

2010 ◽  
Vol 16 (3) ◽  
pp. 168 ◽  
Author(s):  
MohammadA Bhat ◽  
ZahoorA Naikoo ◽  
TufailA Dass ◽  
RiyazA Lone ◽  
AbdulM Dar

Author(s):  
Migle Gedgaudaite ◽  
Arnoldas Bartusevicius ◽  
Saulius Paskauskas ◽  
Daiva Vaiktiene ◽  
Ruta Jolanta Nadisauskiene ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document