Predictors of adequate lymph node harvest during colectomy for colon cancer

648 Background: Adequate lymph node harvest is easily obtained and is necessary for proper staging of colorectal cancer, making it an attractive measure of surgical quality for policy makers. However, achieving an adequate lymph node harvest requires a multidisciplinary effort. The purpose of this study was to determine if it is appropriate to use this measure as a surgical quality indicator for individual surgeons. Methods: The study was undertaken at a high volume center with standardized colon cancer specimen processes. The charts of 1,138 consecutive segmental colon cancer surgeries performed between 2002 and 2008 were retrospectively analyzed. The primary outcome was inadequate lymph node retrieval for colon cancer surgery defined by fewer than 12 lymph nodes on pathology. Predictor variables were based on patient, surgeon, pathology and tumor related factors. Univariate analysis was performed on all potential predictor variables, followed by multivariate logistic regression. Results: 841 cases (69.0%) achieved adequate lymph node harvest, while 377 (31.0%) were inadequate. Factors on univariate analysis associated with inadequate lymph node harvest were specimen length (p<0.0001), tumor location (p<0.0001), and T-stage (0.0015), all of which remained significant multivariate logistic regression. The average specimen length differed by 3.6 cm between non-adequate and adequate specimens. When broken down by procedure, resection length did not vary significantly between high and low volume surgeons or between colorectal and non-colorectal surgeons. Furthermore when surgeons were ranked according to their success rate of >12 LN retrieval, there was no difference between surgeons in mean specimen length. Conclusions: In a high-volume, tertiary care centre that uses standardized practices for specimen processing, 31% of cases yielded fewer than 12 lymph nodes. Factors relating to the patient and tumor were the primary predictors of a successful outcome and there was no association between surgeon-related factor and adequate LN retrieval. Caution should be used when considering LN harvest as a surgical quality indicator for individual surgeons.

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Surgical Treatment of Splenic Flexure Colon Cancer: Does Segmental Resection of the Splenic Flexure Provide an Adequate Lymph Node Harvest?

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.119 ◽

2020 ◽

Vol 231 (4) ◽

pp. S68-S69

Author(s):

Allison Pang ◽

Daniel Marinescu ◽

Gabriela Ghitulescu ◽

Julio Faria ◽

Carol-Ann Vasilevsky ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Surgical Treatment ◽

Splenic Flexure ◽

Segmental Resection ◽

Lymph Node Harvest ◽

Adequate Lymph Node

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Adequacy of lymph node harvest following colectomy for obstructed and nonobstructed colon cancer

Journal of Surgical Oncology ◽

10.1002/jso.26274 ◽

2020 ◽

Author(s):

Arash Azin ◽

Dhruvin H. Hirpara ◽

Arman Draginov ◽

Mohammadali Khorasani ◽

Sunil V. Patel ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Lymph Node Harvest

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Su1765 A Comparison of Lymph Node Harvest Following Emergent Laparoscopic Versus Open Colectomy for Colon Cancer: Results From the ACS-NSQIP Database

Gastroenterology ◽

10.1016/s0016-5085(16)34133-6 ◽

2016 ◽

Vol 150 (4) ◽

pp. S1222

Author(s):

Jad Abou Khalil ◽

Ebram Salama ◽

Philip Gordon ◽

Carol-Ann Vasilevsky ◽

Gabriella Ghitulescu ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Open Colectomy ◽

Lymph Node Harvest ◽

Acs Nsqip ◽

Acs Nsqip Database

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Omission of Adjuvant Chemotherapy Is Associated With Increased Mortality in Patients With T3N0 Colon Cancer With Inadequate Lymph Node Harvest

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000729 ◽

2017 ◽

Vol 60 (1) ◽

pp. 15-21 ◽

Cited By ~ 12

Author(s):

Katerina O. Wells ◽

Alexander T. Hawkins ◽

Devi M. Krishnamurthy ◽

Sekhar Dharmarajan ◽

Sean C. Glasgow ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Node Harvest

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Lymph Node Harvest in Emergent versus Elective Colon Resections

The American Surgeon ◽

10.1177/000313481207801008 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1049-1053 ◽

Cited By ~ 2

Author(s):

Aaron Lewis ◽

Gabriel Akopian ◽

Sharon Carillo ◽

Howard S. Kaufman

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Demographic Data ◽

Tumor Location ◽

Colon Resection ◽

Memorial Hospital ◽

Harvest Lymph Node ◽

Term Survival ◽

Lymph Node Harvest ◽

Emergent Surgery

Quality measures for prognostication of colon cancer include the removal of 12 or more lymph nodes during colon resection. The purpose of this study was to determine whether emergent surgery is associated with inadequate lymph node harvest. The National Cancer Database (NCDB) was queried for colon cancer patients operated on at Huntington Memorial Hospital, Pasadena, California, from 2005 to 2010. Demographic data, indication for surgery, surgeon, stage, lymph node harvest, tumor location, method of surgery, chemotherapy use, and survival were recorded. Univariate analyses were performed to compare lymph node harvest with the variables listed. Three hundred fifty-three patients underwent colon resection between 2005 and 2010. Two hundred ninety-six patients with Stage I to III disease underwent 253 elective (85%) and 43 emergent (15%) colectomies. There was no statistical difference between rates of adequate lymph node harvest in emergent and elective patient groups (86.0 vs 88.1%, P = 0.7). Inferior long-term survival was associated with emergent indication and inferior lymph node harvest. Lymph node harvest adequacy showed a gradual increase over time from 79.5 per cent in 2005 to 95.5 per cent in 2010. Despite a perception that emergent surgery is associated with inadequate lymphadenectomy, 5-year data from Huntington Memorial Hospital participation in NCDB does not suggest inferior lymph node harvests in patients operated on for obstruction or perforation.

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Lymph Node Harvest in Colon Cancer: Influence of Microsatellite Instability and Proximal Tumor Location

World Journal of Surgery ◽

10.1007/s00268-009-0255-4 ◽

2009 ◽

Vol 33 (12) ◽

pp. 2695-2703 ◽

Cited By ~ 58

Author(s):

Kjetil Søreide ◽

Bjørn Steinar Nedrebø ◽

Jon Arne Søreide ◽

Aida Slewa ◽

Hartwig Kørner

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Microsatellite Instability ◽

Tumor Location ◽

Lymph Node Harvest

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Does Obesity Influence Lymph Node Harvest among Patients Undergoing Colectomy for Colon Cancer?

The American Surgeon ◽

10.1177/000313480807401107 ◽

2008 ◽

Vol 74 (11) ◽

pp. 1073-1077 ◽

Cited By ~ 5

Author(s):

Amir A. Damadi ◽

Lucas Julien ◽

Rodrigo Arrangoiz ◽

Manish Raiji ◽

David Weise ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Correlation Coefficients ◽

Sigmoid Colectomy ◽

Obese Patients ◽

Lymph Node Harvest ◽

Significant Difference ◽

The Mean ◽

Nonobese Patients

Adequate lymph node harvest among patients undergoing colectomy for cancer is critical for staging and therapy. Obesity is prevalent in the American population. We investigated whether lymph node harvest was compromised in obese patients undergoing colectomy for cancer. Medical records of patients who had undergone colectomy for colon cancer were reviewed. We correlated the number of lymph nodes with body mass index (BMI) and compared the number of lymph nodes among patients with BMI less than 30 kg/m2 to those with BMI of 30 kg/m2 or greater (“obese”). Among all 191 patients, the correlation coefficient was 0.04 (P > 0.2). The mean number of nodes harvested from 122 nonobese patients was 12.4 ± 6 and that for 69 obese patients 12.8 ± 6 (P > 0.2). Among 130 patients undergoing right colectomy and 35 patients undergoing sigmoid colectomy, the correlation coefficients were 0.02 (P > 0.2) and 0.16 (P > 0.2), respectively. There was not a statistically significant difference in lymph node harvest between obese and nonobese patients (14.1 ± 7 vs 13.8 ± 6, P > 0.2; and 11.8 ± 6 vs 8.6 ± 5, P > 0.2), respectively. Obesity did not compromise the number of lymph nodes harvested from patients undergoing colectomy for colon cancer.

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Does body mass index affect lymph node retrieval in colon resection for cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.13571 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 13571-13571 ◽

Cited By ~ 4

Author(s):

J. M. Pimiento ◽

M. A. Cristancho ◽

K. Aboulhosn ◽

T. Fancher ◽

J. A. Palesty ◽

...

Keyword(s):

Body Mass Index ◽

Colon Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Body Mass ◽

Colon Resection ◽

Fatty Tissue ◽

Specimen Length ◽

Lymph Node Harvest ◽

Lymph Node Retrieval

13571 Background: The management of colon cancer is a multidisciplinary effort that begins with adequate staging centered around the assessment of lymphatic spread. Multiple research groups have studied the number of lymph nodes retrieved and its relation with the outcome of patients with colon cancer, reporting better outcome in patients with a higher number of nodes retrieved. It has been well established that fatty tissue makes lymph node recovery difficult.Our objective was to evaluate if Body Mass Index (BMI) is associated with the number of lymph nodes retrieved, age, stage or location of the tumor. Methods: Retrospective chart review of patient who underwent colon resection for cancer between January 2001 to January 2005. Demographics, BMI and pathologic findings were recorded. Results: 395 patients had diagnosis of colon cancer, 140 underwent surgical procedures for these malignancies. Only 127 patients had complete records. The average age was 72 years. The average lymph node retrieval was 11.4. There was a significant relation between nodes harvested and specimen length (p 0.0028), age (p 0.0011), and stage IV cancer (p 0.002). There was no significant relationship between lymph node retrieval and BMI (p 0.1), location of the tumor (p 0.6) or stage I, II or III. Conclusion: We did not find any statistically significant correlation between BMI and lymph node retrieval, confirming reports that indicate the necessity of adequate lymph node harvest in patients with colon cancer for adequate staging and treatment. This may be because this study was done at a non-specialized center and because the operations were done by a number of different surgeons and the histopathology by numerous pathologists. The relation of improved lymph node harvest with greater specimen length supports other studies that point toward surgical and pathologic techniques as the most important factors in the appropriate staging of colon cancers. Hence, standardized surgical and histopathologic techniques need to be employed for harvesting adequate numbers of lymph nodes in resection specimens because number of nodes is critical to therapy, and an insufficient numbers of nodes may have a detrimental impact on colon cancer patient outcome. A prospective study should be performed in order to confirm the results of this study. No significant financial relationships to disclose.

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