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

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 648-648 ◽  
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.

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

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13571-13571 ◽  
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.

Predictors of adequate lymph node harvest during colectomy for colon cancer

2019 ◽  
Vol 218 (1) ◽  
pp. 113-118 ◽  
Author(s):  
Jeffrey Douaiher ◽  
Tanvir Hussain ◽  
Sean J Langenfeld
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Node Harvest ◽  
Adequate Lymph Node

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

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

scholarly journals Factors associated with pericolic fat stranding of colon cancer on computed tomography colonography

2018 ◽  
Vol 7 (2) ◽  
pp. 205846011875757
Author(s):  
Tsuyoshi Morimoto ◽  
Takayuki Yamada ◽  
Kunihisa Miyakawa ◽  
Yasuo Nakajima
Keyword(s):  
Computed Tomography ◽  
Colon Cancer ◽  
Logistic Regression ◽  
Lymph Node ◽  
Univariate Analysis ◽  
Depth Of Invasion ◽  
Factors Associated ◽  
Longitudinal Length ◽  
Fat Stranding ◽  
Group Comparisons

Background Pericolic fat stranding on computed tomography (CT) scans has been an important feature for staging colon cancer. However, the factors associated with pericolic fat stranding have not been elucidated to date. Purpose To determine factors associated with pericolic fat stranding of colon cancer on CT colonography (CTC). Material and Methods Overall, 150 patients with 155 colon cancer lesions were retrospectively assessed by two radiologists for pericolic fat stranding on CTC. Circumferential proportion of the tumor (CPtumor; <50%, 50–75%, and ≥75%), longitudinal length, depth of invasion (≤T2, T3, T4), lymph node and distant metastasis, and lymphovascular invasion were recorded. Univariate and multivariate logistic regression analyses were performed between pericolic fat stranding and each factor. Multi-group comparisons were performed for the CPtumor and depth of invasion. Results Pericolic fat stranding was identified in 57 lesions (36.8%). Univariate analysis revealed significant associations of pericolic fat stranding with all factors ( P < 0.027), except for lymph node metastasis ( P = 0.087). Multi-group comparisons revealed that pericolic fat stranding was more frequent with increasing CPtumor ( P < 0.001); however, no significant differences were observed beyond subserosal infiltration ( P = 0.225). Logistic regression analysis revealed the CPtumor (<75% vs. ≥75%; P = 0.008, <50% vs. 50–75%; P = 0.047) and longitudinal length ( P = 0.001) as explainable variables. Conclusion Pericolic fat stranding identified on CT images of colon cancer is demonstrated more frequently with increasing circumferential proportion of the tumor and longitudinal length.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
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.

Does obesity impact lymph node retrieval in colon cancer surgery?

2010 ◽  
Vol 200 (4) ◽  
pp. 478-482 ◽  
Author(s):  
Jared H. Linebarger ◽  
Michelle A. Mathiason ◽  
Kara J. Kallies ◽  
Stephen B. Shapiro
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Cancer Surgery ◽  
Lymph Node Retrieval ◽  
Colon Cancer Surgery

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

2020 ◽  
Author(s):  
Arash Azin ◽  
Dhruvin H. Hirpara ◽  
Arman Draginov ◽  
Mohammadali Khorasani ◽  
Sunil V. Patel ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Node Harvest

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

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

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

2017 ◽  
Vol 60 (1) ◽  
pp. 15-21 ◽  
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

Effect of Surgical Approach on Node Harvest in Robotic Gastrectomy

2019 ◽  
Vol 85 (8) ◽  
pp. 794-799
Author(s):  
Michael D. Watson ◽  
Sally J. Trufan ◽  
Nicole L. Gower ◽  
Joshua S. Hill ◽  
Jonathan C. Salo
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Surgical Approach ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Laparoscopic Approach ◽  
Robotic Gastrectomy ◽  
Robotic Approach ◽  
Lymph Node Harvest

There has been increasing utilization of minimally invasive surgical approaches. This study evaluates the effect of surgical approach on total lymph node harvest in gastrectomy. Patients undergoing gastrectomy for gastric adenocarcinoma between 2007 and 2018 were reviewed retrospectively. Data collected included age, gender, race, BMI, neoadjuvant therapy, tumor stage, surgical approach, and total number of lymph nodes harvested. The total number of harvested lymph nodes for open, laparoscopic, and robotic gastrectomy was compared using the Kruskal-Wallis test for univariate analysis and a Poisson regression model for multivariable analysis. One hundred four patients were identified. Median node harvest for open, laparoscopic, and robotic approaches were 16, 17, and 36, respectively. Multivariable analysis controlling for gender, BMI, pathological T stage, and year of operation demonstrates that surgical approach is statistically significantly associated with lymph node harvest ( F = 83.4, P < 0.0001). In multivariable analysis, robotic approach was associated with greater lymph node harvest than both open ( P < 0.0001) and laparoscopic ( P < 0.0001) approaches, whereas laparoscopic approach was associated with greater lymph node harvest than open ( P < 0.0001) approach. These data demonstrate that for patients undergoing gastrectomy for gastric adenocarcinoma at our institution, robotic approach is associated with greater lymph node harvest than both laparoscopic and open approaches.

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