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

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.

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

2008 ◽  
Vol 74 (11) ◽  
pp. 1073-1077 ◽  
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.

Assessing the impact of a targeted educational initiative on colorectal cancer lymph node retrieval: A Fox Chase Cancer Center Partners' quality initiative

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6524-6524
Author(s):  
B. Curley ◽  
M. A. O'Grady ◽  
S. Litwin ◽  
K. Stitzenberg ◽  
H. Armitage ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Center ◽  
Community Hospitals ◽  
Educational Initiative ◽  
Tumor Boards ◽  
Nodal Yield ◽  
The Impact

6524 Background: The retrieval of ≥12 lymph nodes in a colorectal cancer surgical specimen is an established quality metric. The impact of targeted education to improve nodal yield at community hospitals has not been studied. We initiated an intensive educational program through the Fox Chase Cancer Center Partner (FCCCP) hospitals to improve nodal retrieval in colon cancer specimens. Methods: At 12 FCCCP community hospitals from 2004–05, educational initiatives were conducted by FCCC staff and included group presentations at hospital tumor boards, cancer and quality committees, and regional CME. Individual presentations to pathologists and surgeons were held. Tumor registry data were retrospectively collected from FCCCP from 2003 (pre-intervention) to 2006 (post-intervention) for patients undergoing curative colon cancer surgery. Data abstracted were age, sex, race, stage, surgical procedure, and total number of nodes examined. The primary end point was % surgical specimens with ≥12 lymph nodes. Obtaining at least 250 records per year would allow ≥90% power to detect a change from a baseline level of ∼40% to ≥50% after intervention. Results: Data from 4,208 patients from 12 FCCCP hospitals were collected. Overall characteristics: male/female (48%/52%), race (W 83%, AA 7%, other 10%), age (<50:6%, 50–70: 34%, >70:60%), node ± (39%/61%). The % of colon cancer operations with ≥12 nodes significantly increased over the four years of the study (Table, p<.00001). This difference persisted when pooling years before and after the intervention (2003–04 vs. 2005–06, p <0.0001). There was no difference in nodal yield between two pre-intervention years (2003 vs. 2004, p=0.1). No differences in other characteristics such as age, sex, race, or % lymph node positive were noted between years. Conclusions: A multi-intervention targeted educational initiative in a large community cancer network is feasible and associated with increased colon cancer nodal retrieval. [Table: see text] No significant financial relationships to disclose.

scholarly journals A comparison of clinicopathologic features of the patients with colorectal cancer cfter emergency and elective surgery

2021 ◽  
pp. 22-30
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Node Dissection ◽  
Common Procedure ◽  
Surgery Group ◽  
Significant Difference ◽  
The Mean ◽  
Surgical Conditions

The importance of oncologic principles in colorectal cancer has been particularly emphasized in recent years. There are several studies on the quality of the conditions of emergency surgery and comparison of stage, mortality and morbidity rates between patient who underwent emergency and elective surgery. This study aimed to investigate and compare the clinicopathologic characteristics of patients with colorectal cancer according to their surgical conditions whether urgent or elective. Medical records of 564 patients, who underwent colorectal resection between January 2011 and March 2017 anddiagnosed with colon/rectum adenocarcinoma after pathological examination, were investigated ret-rospectively. There were 104 (18.4%) patients in the emergency surgery group and 460 (81.6%) patients in the electi-ve surgery group. Majority of the patients were male61.2%, and the mean age was 64.27. The patients who had rectal tumor were 19.7% of all cases, and the tumor was located in colonic segments in the remaining 80.3%. Low anterior resection was determined as the most common procedure with the percentage of 23.2%. Anterior resection was the most common procedure in emergency surgery group (27.9%). There was no significant difference between the mean lymph node count in terms of the type of the operation, on the basis of surgical condition. When the factors such as age, gender, tumor location, type of the operation and stage of cancer that have effects on adequate lymph node dissection, were analyzed; the only statistically significant difference was found between emergency and elective cases of the transverse colon tu-mors (p<0.05). While postoperative complications had no effect on the length of hospital stay, having an os-tomy and an advanced cancer found to be prolonging this duration (p<0.05). Surgical conditions have been shown to not affect the lymph node dissection which is an important factor determining the oncological process of the patient.

scholarly journals 100 ROBOTIC-ASSISTED OPERATIONS IN COLORECTAL CANCER (FIRST OUTCOMES)

2015 ◽  
Vol 174 (6) ◽  
pp. 80-84 ◽  
Author(s):  
D. V. Gladyshev ◽  
S. A. Kovalenko ◽  
M. E. Moiseev ◽  
S. S. Gnedash ◽  
A. M. Karachun ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Hospital Stay ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Treatment Results ◽  
Robotic Assisted ◽  
Significant Difference ◽  
First Results

This article analyzed the immediate treatment results of 210 patients, underwent endovideosurgical operative treatment concerning colorectal cancer (106 laparoscopic and 104 robotic-assisted operations). According to the first results, there was no significant difference between two methods in such medical indices as the volume of intraoperative hemorrhage, terms of hospital stay and peristalsis recovery, the rate of conversion and complications in early postoperative period, quantity of removed lymph nodes, quality of TME. The application of robotics allowed performance of precision work in conditions of limited space of the small pelvis.

scholarly journals A comparison of formalin and GEWF in fixation of colorectal carcinoma specimens: rates of lymph node retrieval and effect on TNM staging

2015 ◽  
Vol 69 (6) ◽  
pp. 511-517 ◽  
Author(s):  
Joanne Horne ◽  
Norman J Carr ◽  
Adrian C Bateman ◽  
Ngianga Kandala ◽  
Jody Adams ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Neoadjuvant Therapy ◽  
Point Estimate ◽  
Lymph Node Yield ◽  
Lymph Node Retrieval ◽  
Significant Difference ◽  
Mean Size ◽  
The Mean ◽  
Long Course

AimsThe Royal College of Pathologists recommend that a median of at least 12 lymph nodes should be harvested during pathological staging of colorectal cancer. It is not always easy to harvest the required number, especially in patients with rectal cancer receiving neoadjuvant therapy. Lymph node revealing solutions, for example, GEWF, may improve nodal yield. GEWF is safe, cheap and easy to use.MethodsIn a controlled trial, lymph node yields were compared after secondary specimen dissection following either 24 h of further fixation in formalin (n=101) or GEWF immersion (n=99). The number, size and tumour status of additional lymph nodes identified were compared between groups. Twenty-seven cases that received long-course neoadjuvant therapy were also assessed.ResultsMedian lymph node yield at primary dissection met national standards overall (19) but also in the long-course neoadjuvant therapy group (13). Lymph nodes were smaller in neoadjuvant cases compared with non-neoadjuvant cases (mean size range 1.3–5.6 mm vs 1.5–8.9 mm). The use of further fixation and GEWF detected more nodes at secondary dissection. The mean number of additional nodes harvested was greater with formalin (8.3) than GEWF (7.3). There was no significant difference in the mean size of the additional lymph nodes detected between groups (point estimate 1.02; 95% CI −0.58 to 2.63; p=0.211). Upstaging triggering adjunct chemotherapy occurred in 1% (2/200) of cases.ConclusionsThe routine use of adjunct techniques to identify additional lymph nodes is unnecessary with underlying high-quality dissection practice. Emphasis should be placed upon education and training, spending appropriate time dissecting and ensuring specimens are sufficiently fixed beforehand.

Increased lymph node harvest from colorectal cancer resections using GEWF solution: a randomised study

2008 ◽  
Vol 61 (11) ◽  
pp. 1203-1208 ◽  
Author(s):  
L H Iversen ◽  
S Laurberg ◽  
R Hagemann-Madsen ◽  
H Dybdahl
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
University Hospital ◽  
Node Negative ◽  
Lymph Node Harvest ◽  
Randomised Study ◽  
Standard Manner ◽  
N Stage ◽  
Tumour Origin

Background:The lymph node harvest from colorectal specimens is pivotal for patients with colorectal cancer (CRC), independent of N stage.Aims:To determine whether the use of GEWF solution (glacial acetic acid, ethanol, distilled water and formaldehyde) could improve the lymph node harvest in CRC specimens.Methods:Consecutive fresh colonic (n = 60) and rectal (n = 60) specimens from patients with primary CRC resected at Aarhus University Hospital THG between March 2006 and July 2007 were randomised to either conventional preparation or GEWF preparation and examined in a standard manner.Results:For colonic as well as rectal specimens, the GEWF solution increased the mean lymph node harvest from 9 and 10 to 16 and 17 lymph nodes per specimen compared to conventional prepared specimens (p<0.001). Using the recommended threshold of 12 lymph nodes to ensure adequacy of nodal harvest, the adequacy increased from less than half to almost three quarters independent of tumour origin (p<0.037). The proportion of node-negative specimens was not significantly different between the two preparation groups.Conclusion:The use of GEWF solution in patients with CRC significantly increases the lymph node harvest of resected specimens.

Metastatic lymph node ratio as better prognostic tool than TNM system in colorectal cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16128-e16128
Author(s):  
Filipa Macedo ◽  
Hugo Sequeira ◽  
Katia Ladeira ◽  
Nuno Bonito ◽  
Charlene Viana ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Venous Invasion ◽  
Lymph Node Status ◽  
Tnm System ◽  
Metastatic Lymph ◽  
Node Ratio ◽  
The Impact

e16128 Background: Colorectal cancer (CRC) is the third leading cause of cancer death in the world. Lymph node metastasis is an important prognostic factor; however, the minimum number of lymph nodes that should be evaluated for adequately categorizing lymph node status is still a controversial theme. The TNM staging system has limitations in defining the pN category. The lymph node ratio (LNR) may be a better prognostic indicator. Objectives: Evaluate the impact on the prognosis of patients operated for CRC, comparing the LNR with the pN category of TNM system. Methods: We studied 1065 patients treated at a General Surgery Department from 01/01/2000 to 08/31/2012. The LNR was separated into 5 categories based on three previously calculated cut-off values: LNR0 (0), LNR1 (0.01-0.17), LNR2 (0.18- 0.41), LNR3 (0.42-0.69) and LNR4 (≥0.70). Results: The results of the univariate analysis indicated significant differences in survival according to age (p < 0.001), tumor size (p < 0.001), serosal invasion (p < 0.001), histological type (p = 0.002), differentiation (p < 0.001), pT (p < 0.001), pN (p < 0.001), LNR (p < 0.001), M (p = 0.001), TNM stage (p < 0.001), venous invasion (p < 0.001). Multivariate analysis confirmed the LRN, pN, age, venous invasion and pT as independent prognostic factors. The survival analysis showed significant differences between the categories of pN (p < .001) and LNR (p < .001). Spearman correlation analysis showed a significant correlation between the total number of dissected lymph nodes and the number of metastatic lymph nodes (rs = 0.167, p < 0.001). The total number of dissected lymph nodes is not significantly correlated with LNR (rs = -0.019, p = 0.550). Conclusions: In this study LNR seems to demonstrate a superior prognostic value when compared to the pN categories, in part due to its greater independence regarding the extent of lymphadenectomy.

Robotic-Assisted Video Endoscopic Inguinal Lymphadenectomy in Carcinoma Vulva: Our Experiences and Intermediate Results

2016 ◽  
Vol 27 (1) ◽  
pp. 159-165 ◽  
Author(s):  
Vandana Jain ◽  
Rupinder Sekhon ◽  
Shveta Giri ◽  
Nahida Hassan ◽  
Kanika Batra ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Inguinal Lymph Node ◽  
Node Dissection ◽  
Inguinal Lymph Node Dissection ◽  
Open Procedure ◽  
Robotic Assisted ◽  
Inguinal Lymphadenectomy ◽  
The Mean

ObjectivesTo describe the technique of robotic-assisted video endoscopic inguinal lymphadenectomy (R-VEIL) in patients with carcinoma vulva and discuss the advantages of the technique and oncological outcome.MethodsTwelve patients of squamous cell cancer of vulva underwent 22 R-VEIL procedures from February 2011 to February 2015. Their preoperative, intraoperative, and postoperative data were retrospectively analysed.ResultsThe mean age of patients was 61 years (range, 32–78 years). The mean operative time was 69.3 minutes (range, 45–95 minutes). The mean blood loss was 30 mL (range, 15–50 mL). No intraoperative complication was observed. The mean drain output was 119 mL (range, 50–250 mL), and the drains were removed at a mean of 13.9 days (range, 8–38 days). The average number of superficial and deep inguinofemoral lymph nodes retrieved was 11 (range, 4–26). Two patients had positive lymph nodes on histopathology (16.67%). Postoperative complications were lymphocele (6 groins), chronic lower limb lymphedema (6 cases), prolonged lymphorrhea (1 groin), and cellulitis (2 groins). Over a follow-up period ranging from 7 to 67 months, 1 patient developed recurrence in the inguinal nodes and died 7 months after the recurrence.ConclusionsThe R-VEIL allows the removal of inguinal lymph nodes within the same limits as the open procedure for inguinal lymph node dissection and has a potential to reduce the surgical morbidity associated with the open procedure. Long-term oncological results are not available though our initial results appear promising. Prospective multi-institutional studies are required to prove its efficacy over open inguinal lymph node dissection.

The Impact of the Ratio of Positive to Total Lymph Nodes Examined and Outcome in Colorectal Cancer

2009 ◽  
Vol 75 (10) ◽  
pp. 873-876
Author(s):  
Melody Ng ◽  
Sharmila Roy-Chowdhury ◽  
Sharon S. Lum ◽  
John W. Morgan ◽  
Jan H. Wong
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Prognostic Significance ◽  
Lower Percentage ◽  
Node Positive ◽  
N2 Disease ◽  
California Cancer Registry ◽  
The Mean ◽  
The Impact

We sought to examine the significance of the number of nodes examined in node-positive colorectal cancer. Between January 1, 1994, and December 31, 2003, 7192 patients with colorectal cancer underwent potentially curative resection in Region 5 of the California Cancer Registry. Of these patients, 2636 patients were node-positive: 65.1 per cent were N1 and 34.9 per cent were N2. The median follow up was 39.5 months. The mean number of nodes examined was 10.4 (range, 1-89) for NO, 11.0 (range, 1-72) for N1, and 14.6 (range, 4-79) for N2 ( P < 0.0001). N1 and N2 patients were stratified according to the percentage of positive nodes into quintiles (0.19 or less, 0.20 to 0.39, 0.40 to 0.59, 0.60 to 0.79, and 0.80 to 1.0). In both N1 and N2 disease, a lower percentage of lymph nodes involved with metastatic disease was associated with improved survival ( P < 0.0001). The increasing ratio of positive to total nodes was the result of a decrease in the total number of nodes examined in N1 disease and a steeper decline in total nodes examined in relation to the increase in the number of positive nodes in N2 disease. The ratio of positive to total nodes has prognostic significance in node-positive colorectal cancer.

The impact of lymph node dissection in patients with colorectal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17055-17055
Author(s):  
R. W. Gentry ◽  
R. Govindarajan ◽  
H. J. Spencer ◽  
G. Dykstra-Long
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Node Negative ◽  
Time Of Surgery ◽  
Node Positive ◽  
Node Positive Disease ◽  
The Impact

17055 Background: The role of extended lymphadenectomy on survival of patients with colorectal cancer is unclear. Survival in these patients is inversely proportional to the stage of disease. The prognostic significance of inadequate lymph node dissection is not understood. To understand the impact of the number of lymph nodes removed at the time of surgery on survival, we conducted a retrospective study of patients with colorectal cancer treated at the Central Arkansas Veterans Healthcare System, Little Rock, AR. Methods: Data on 531 patients with a diagnosis of colorectal cancer from January 1991 to October 2005 was obtained from the tumor registry. The number of lymph nodes dissected the number of positive and negative lymph nodes for each patient, treatment received and overall survival was analyzed. The number of resected nodes was grouped as follows: none (LNG0), 1–5 (LNG1), 6–10 (LNG2), and > 10 (LNG3). Log rank test was used to evaluate difference in survival between the groups. Results: There were 451 Caucasians, 80 African Americans, 523 males and 8 females in the study. The median age was 69 yrs (range: 29–100). Rectal cancer patients had fewer nodes dissected compared to colon cancer (p <0.001). There was no survival difference between LNG0, LNG1, LNG2 and LNG3 (p=0.435). The number of lymph nodes removed did not have an impact on survival among those who had node negative disease (0.435) and node positive (0.458) disease. LNG0 patients had the same prognosis as those with node negative disease (P=0.435) who had better survival compared to node positive disease. (p=0.029). However, LNG0 patients had similar survival compared to LNG1 subset of patients and those in LNG3 had a trend towards better survival, though not statistically significant. LNG0 subjects received less chemotherapy (p=0.018) and radiation therapy (p=0.01) compared to those who had lymphadenectomy. Conclusions: The number of nodes removed at the time of surgery did not affect survival in subjects with node negative and node positive disease. Patients who did not have any identifiable nodes at the time of surgery had the same prognosis as those who had node negative disease. Patients with more than 10 negative nodes dissected had a trend towards better survival although not statistically significant. No significant financial relationships to disclose.

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