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

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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Should lymph node retrieval be a surgical quality indicator in colon cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.648 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 648-648 ◽

Cited By ~ 1

Author(s):

Reilly Patrick Musselman ◽

Mingyang Xie ◽

Kelsey McLaughlin ◽

Husein Moloo ◽

Robin P Boushey ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Quality Indicator ◽

Univariate Analysis ◽

High Volume ◽

Specimen Length ◽

Surgical Quality ◽

Lymph Node Harvest ◽

Lymph Node Retrieval ◽

Adequate Lymph Node

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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Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study

Gastroenterology Research and Practice ◽

10.1155/2019/5197914 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Elena Orsenigo ◽

Giulia Gasparini ◽

Michele Carlucci

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Patients ◽

Rank Test ◽

Lymph Node Yield ◽

Log Rank Test ◽

Lymph Node Retrieval

Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08±11.4, 20.34±11.8, and 15.33±9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (P=0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival (P=0.055, log-rank test). Multiple tumor and patients’ factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.

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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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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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Neoadjuvant Chemotherapy is Associated with Lower Lymph Node Counts in Colon Cancer

The American Surgeon ◽

10.1177/000313481808400655 ◽

2018 ◽

Vol 84 (6) ◽

pp. 996-1001

Author(s):

Matthew G. Mullen ◽

Puja M. Shah ◽

Alex D. Michaels ◽

Taryn E. Hassinger ◽

Florence E. Turrentine ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Preoperative Chemotherapy ◽

Improvement Program ◽

Data Set ◽

Lymph Node Yield ◽

Factors Associated ◽

Lymph Node Retrieval

Adequate lymphadenectomy is associated with improved survival in patients who undergo oncologic resection of colorectal cancer and has been identified as a quality metric. Neoadjuvant chemotherapy has been found to be associated with collection of <12 lymph nodes in patients with rectal cancer. The purpose of this study was to evaluate patient and operative risk factors for inadequate lymph node retrieval during oncologic colectomy. The 2014 American College of Surgeons National Surgical Quality Improvement Program Participant Use File data set for oncologic colectomy (n = 9077) was analyzed. Patient- and operation-related factors were assessed by univariate and multivariate regression analyses to determine factors associated with the number of lymph nodes collected. Adequate lymphadenectomy was defined by collection of >12 lymph nodes. Of 9077 patients with a diagnosis of colon cancer who underwent colectomy, a minimum of 12 lymph nodes was harvested in 7897 (87%). Significant factors independently associated with inadequate lymphadenectomy included preoperative chemotherapy, emergent surgery, and T1 tumors (all P < 0.05). A large majority of patients who undergo colectomy for colon cancer have at least 12 lymph nodes collected. Preoperative chemotherapy is a major risk factor for inadequate lymph node retrieval. Recognition of factors associated with inadequate lymphadenectomy may improve colectomy lymph node yield and survival in patients with colon cancer.

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Improved Tissue Processing in Esophageal Adenocarcinoma After Ivor Lewis Esophagectomy Allows Histological Analysis of All Surgically Removed Lymph Nodes with Significant Effects on Nodal UICC Stages

Annals of Surgical Oncology ◽

10.1245/s10434-020-09450-1 ◽

2020 ◽

Author(s):

A. Quaas ◽

H. Schloesser ◽

H. Fuchs ◽

T. Zander ◽

C. Arolt ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Esophageal Adenocarcinoma ◽

Neoadjuvant Treatment ◽

Prognostic Impact ◽

Fatty Tissue ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Lymph Node Retrieval

Abstract Background In esophageal carcinoma, the numbers of metastatic and total removed lymph nodes (LN) are well-established variables of long-term prognosis. The overall rate of retrieved LN depends on neoadjuvant treatment, the extent of surgical lymphadenectomy, and the modality of the pathological workup. The question in this study is whether technically extended histopathological preparation can increase the number of detected (metastatic) LN with an impact on nodal UICC staging. Patients and Methods A cohort of 77 patients with esophageal adenocarcinoma was treated with Ivor Lewis esophagectomy including standardized two-field lymphadenectomy. The specimens were grossed, and all manually detectable LN were retrieved. The remaining tissue was completely embedded by the advanced “acetone compression” retrieval technique. The primary outcome parameter was the total number of detected lymph nodes before and after acetone workup. Results A mean number of 23,1 LN was diagnosed after standard manual LN preparation. With complete embedding of the fatty tissue using acetone compression, the number increased to 40.5 lymph nodes (p < 0.0001). The mean number of metastatic LN increased from 3.2 to 4.2 nodal metastases following acetone compression (p < 0.0001). Additional LN metastases which caused a change in the primary (y)pN stage were found in ten patients (13.0%). Conclusions Advanced lymph node retrieval by acetone compression allows a reliable statement on the real number of removed LN. Results demonstrate an impact on the nodal UICC stage. A future multicenter study will examine the prognostic impact of improved lymph node retrieval on long-term oncologic outcome.

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