Lymph node harvest in colon cancer
Myths and magic
DOI:
https://doi.org/10.29193/RMU.36.2.8Keywords:
COLONIC NEOPLASMS, NEOPLASMS STADING, LYMPH NODE HARVESTAbstract
Lymph node compromise is critical in colon cancer staging, as a prognostic factor and to determine adjuvant therapy. The number of lymph nodes to be resected is still under discussion, as well as the factor that have an impact on lymph node harvest and its biological significance.
We reviewed clinical variables and variables that are specific to the tumor, what results in the definition of a certain number of lymph nodes, as the adequate Gold Standard for lymph node harvest being controversial.
12 is not necessarily a “magic” number that marks quality. Extending resection to increase lymph node harvest does not improve staging, it exposes patients to unnecessary risks, there being no therapeutic effect guaranteed. The “Magic” continues to be routine resection that includes the cystic pedicle and the area around the tumour, adjusting resection to the patient’s characteristics. Less is not best, but more is not necessarily better.
References
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(25) Costa G, Lorenzon L, Massa G, Frezza B, Ferri M, Fransvea P, et al. Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis. Int J Colorectal Dis 2017; 32(10):1453-61.
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(31) Edler D, Ohrling K, Hallström M, Karlberg M, Ragnhammar P. The number of analyzed lymph nodes - a prognostic factor in colorectal cancer. Acta Oncol 2007; 46(7):975-81.
(32) Chang G, Rodriguez-Bigas M, Skibber J, Moyer V. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007; 99(6):433-41.
(33) Törnroos A, Garvin S, Olsson H. The number of identified lymph node metastases increases continuously with increased total lymph node recovery in pT3 colon cancer. Acta Oncol 2009; 48(8):1152-6.
(34) Törnroos A, Shabo I, Druvefors B, Arbman G, Olsson H. Postoperative intra-arterial methylene blue injection of colorectal cancer specimens increases the number of lymph nodes recovered. Histopathology 2011; 58(3):408-13.
(35) Choi H, Law W, Poon J. The optimal number of lymph nodes examined in stage II colorectal cancer and its impact of on outcomes. BMC Cancer 2010; 10:267.
(36) O’Boyle S, Stephenson K. More is better: lymph node harvesting in colorectal cancer. Am J Surg 2017; 213(5):926-30.
(37) Gravante G, Parker R, Elshaer M, Mogekwu A, Humayun N, Thomas K, et al. Lymph node retrieval for colorectal cancer: Estimation of the minimum resection length to achieve at least 12 lymph nodes for the pathological analysis. Int J Surg 2016; 25:153-7.
(38) Stracci F, Bianconi F, Leite S, Liso A, La Rosa F, Lancellotta V, et al. Linking surgical specimen length and examined lymph nodes in colorectal cancer patients. Eur J Surg Oncol 2016; 42(2):260-5.
(39) Khan H, Olszewski A, Somasundar P. Lymph node involvement in colon cancer patients decreases with age; a population based analysis. Eur J Surg Oncol 2014; 40(11):1474-80.
(40) Lee L, Erkan A, Alhassan N, Kelly J, Nassif G, Albert M, et al. Lower survival after right-sided versus left-sided colon cancers: Is an extended lymphadenectomy the answer? Surg Oncol 2018; 27(3):449-55.
(41) Parsons H, Tuttle T, Kuntz K, Begun J, McGovern P, Virnig B. Association between lymph node evaluation for colon cancer and node positivity over the past 20 years. JAMA 2011; 306(10):1089-97.
(42) Budde C, Tsikitis V, Deveney K, Diggs B, Lu K, Herzig D. Increasing the number of lymph nodes examined after colectomy does not improve colon cancer staging. J Am Coll Surg 2014; 218(5):1004-11.
(43) Del Paggio J, Nanji S, Wei X, MacDonald P, Booth C. Lymph node evaluation for colon cancer in routine clinical practice: a population-based study. Curr Oncol 2017; 24(1):e35-e43. doi: 10.3747/co.24.3210.
(44) Kawamura Y, Umetani N, Sunami E, Watanabe T, Masaki T, Muto T. Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement. Eur J Surg 2000; 166(10):803-7.
(45) Canessa C, Badía F, Fierro S, Fiol V, Háyek G. Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum 2001; 44(9):1333-6.
(46) Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J. Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 2011; 98(8):1171-8.
(47) Bertelsen C, Neuenschwander A, Jansen J, Kirkegaard-Klitbo A, Tenma J, Wilhelmsen M, et al. Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg 2016; 103(5):581-9.
(48) Fan Y, Ning F, Zhang C, Dai D. Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: a meta-analysis. Int J Surg 2018; 52:269-77.
(49) Paquette I, Madoff R, Sigurdson E, Chang G. Impact of proximal vascular ligation on survival of patients with colon cancer. Ann Surg Oncol 2018; 25(1):38-45.
(50) Manceau G, Cotte E. Colectomie angulaire gauche vs colectomie subtotale dans les cancers de l’angle colique gauche. Colon Rectum 2017; 11:259–63.
(51) Märkl B, Schaller T, Kokot Y, Endhardt K, Kretsinger H, Hirschbühl K, et al. Lymph node size as a simple prognostic factor in node negative colon cancer and an alternative thesis to stage migration. Am J Surg 2016; 212(4):775-80.
(2) Johnson P, Malatjalian D, Porter G. Adequacy of nodal harvest in colorectal cancer: a consecutive cohort study. J Gastrointest Surg 2002; 6(6):883-88.
(3) Böckelman C, Engelmann B, Kaprio T, Hansen T, Glimelius B. Risk of recurrence in patients with colon cancer stage II and III: a systematic review and meta-analysis of recent literature. Acta Oncol 2015; 54(1):5-16.
(4) Lisovsky M, Schutz S, Drage M, Liu X, Suriawinata A, Srivastava A. Number of lymph nodes in primary nodal basin and a “second look” protocol as quality indicators for optimal nodal staging of colon cancer. Arch Pathol Lab Med 2017; 141(1):125-30.
(5) Reha J, Mukkamalla S, Rathore R, Somasundar P. Adequate lymph node evaluation in the elderly is associated with improved survival in patients with stage I-III colon cancer: a validation study using the National Cancer Data Base. Eur J Surg Oncol 2018; 44(1):148-56.
(6) Xue L, Williamson A, Gaines S, Andolfi C, Paul-Olson T, Neerukonda A, et al. An update on colorectal cancer. Curr Probl Surg 2018; 55(3):76-116.
(7) Resch A, Langner C. Lymph node staging in colorectal cancer: old controversies and recent advances. World J Gastroenterol 2013; 19(46):8515-26.
(8) Willaert W, Mareel M, Van De Putte D, Van Nieuwenhove Y, Pattyn P, Ceelen W. Lymphatic spread, nodal count and the extent of lymphadenectomy in cancer of the colon. Cancer Treat Rev 2014; 40(3):405-13.
(9) Fielding L, Arsenault P, Chapuis P, Dent O, Gathright B, Hardcastle, et al. Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol 1991; 6(4):325-44.
(10) Pickren J. Current concepts in cancer: nodal clearance and detection. JAMA 1975; 231(9):969-71.
(11) Scott K, Grace R. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989; 76(11):1165-7.
(12) Amri R, Klos C, Bordeianou L, Berger D. The prognostic value of lymph node ratio in colon cancer is independent of resection length. Am J Surg 2016; 212(2):251-7.
(13) Li Destri G, Di Carlo I, Scilletta R, Scilletta B, Puleo S. Colorectal cancer and lymph nodes: the obsession with the number 12. World J Gastroenterol 2014; 20(8):1951-60.
(14) Parsons H, Begun J, Kuntz K, Tuttle T, McGovern P, Virnig B. Lymph node evaluation for colon cancer in an era of quality guidelines: who improves? J Oncol Pract 2013; 9(4):e164-71.
(15) Backes Y, Elias S, Bhoelan B, Groen J, van Bergeijk J, Seerden T, et al. The prognostic value of lymph node yield in the earliest stage of colorectal cancer: a multicenter cohort study. BMC Med 2017; 15(1):129.
(16) Hamza A, Sakhi R, Khawar S, Alrajjal A, Edens J, Khurram M, et al. Role of “second look” lymph node search in harvesting optimal number of lymph nodes for staging of colorectal carcinoma. Gastroenterol Res Pract 2018; 2018:1985031. doi: 10.1155/2018/1985031.
(17) Garcia B, Guzman C, Johnson C, Hellenthal N, Monie D, Monzon J. Trends in lymph node excision and impact of positive lymph node ratio in patients with colectomy for primary colon adenocarcinoma: population based study 1988 to 2011. Surg Oncol 2016; 25(3):158-63.
(18) Fang S, Efron J, Berho M, Wexner S. Dilemma of stage II colon cancer and decision making for adjuvant chemotherapy. J Am Coll Surg 2014; 219(5):1056-69.
(19) Liu J, Huffman K, Palis B, Shulman L, Winchester D, Ko C, Hall B. Reliability of the American College of Surgeons Commission on Cancer’s Quality of Care Measures for Hospital and Surgeon Profiling. J Am Coll Surg 2017; 224(2):180-190.e8. doi: 10.1016/j.jamcollsurg.2016.10.053.
(20) Betge J, Harbaum L, Pollheimer M, Lindtner R, Kornprat P, Ebert M, et al. Lymph node retrieval in colorectal cancer: determining factors and prognostic significance. Int J Colorectal Dis 2017; 32(7):991-8.
(21) Tekkis P, Smith J, Heriot A, Darzi A, Thompson M, Stamatakis J. A national study on lymph node retrieval in resectional surgery for colorectal cancer. Dis Colon Rectum 2006; 49(11):1673-83.
(22) Shen S, Haupt B, Ro J, Zhu J, Bailey H, Schwartz M. Number of lymph nodes examined and associated clinicopathologic factors in colorectal carcinoma. Arch Pathol Lab Med 2009; 133(5):781-6.
(23) Wood P, Peirce C, Mulsow J. Non-surgical factors influencing lymph node yield in colon cancer. World J Gastrointest Oncol 2016; 8(5):466-73.
(24) Martínez-Ramos D, Escrig-Sos J, Miralles-Tena J, Rivadulla-Serrano I, Salvador-Sanchís J. ¿Existe un número mínimo de ganglios linfáticos que se debe analizar en la cirugía del cáncer colorrectal? Cir Esp 2008; 83(3):108-17.
(25) Costa G, Lorenzon L, Massa G, Frezza B, Ferri M, Fransvea P, et al. Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis. Int J Colorectal Dis 2017; 32(10):1453-61.
(26) Patel S, Patel S, Brackstone M. Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery. Can J Surg 2014; 57(5):349-53.
(27) van Erning F, Crolla R, Rutten H, Beerepoot L, van Krieken J, Lemmens V. No change in lymph node positivity rate despite increased lymph node yield and improved survival in colon cancer. Eur J Cancer 2014; 50(18):3221-9.
(28) Fingerhut A. What counts most in the lymph node count for colorectal cancer? Surg Innov 2012; 19(3):213-5.
(29) Le Voyer T, Sigurdson E, Hanlon A, Mayer R, Macdonald J, Catalano P, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003; 21(15):2912-9.
(30) Tsai H, Huang C, Yeh Y, Ma C, Chen C, Lu C, et al. Factors affecting number of lymph nodes harvested and the impact of examining a minimum of 12 lymph nodes in stage I-III colorectal cancer patients: a retrospective single institution cohort study of 1167 consecutive patients. BMC Surg 2016; 16:17.
(31) Edler D, Ohrling K, Hallström M, Karlberg M, Ragnhammar P. The number of analyzed lymph nodes - a prognostic factor in colorectal cancer. Acta Oncol 2007; 46(7):975-81.
(32) Chang G, Rodriguez-Bigas M, Skibber J, Moyer V. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007; 99(6):433-41.
(33) Törnroos A, Garvin S, Olsson H. The number of identified lymph node metastases increases continuously with increased total lymph node recovery in pT3 colon cancer. Acta Oncol 2009; 48(8):1152-6.
(34) Törnroos A, Shabo I, Druvefors B, Arbman G, Olsson H. Postoperative intra-arterial methylene blue injection of colorectal cancer specimens increases the number of lymph nodes recovered. Histopathology 2011; 58(3):408-13.
(35) Choi H, Law W, Poon J. The optimal number of lymph nodes examined in stage II colorectal cancer and its impact of on outcomes. BMC Cancer 2010; 10:267.
(36) O’Boyle S, Stephenson K. More is better: lymph node harvesting in colorectal cancer. Am J Surg 2017; 213(5):926-30.
(37) Gravante G, Parker R, Elshaer M, Mogekwu A, Humayun N, Thomas K, et al. Lymph node retrieval for colorectal cancer: Estimation of the minimum resection length to achieve at least 12 lymph nodes for the pathological analysis. Int J Surg 2016; 25:153-7.
(38) Stracci F, Bianconi F, Leite S, Liso A, La Rosa F, Lancellotta V, et al. Linking surgical specimen length and examined lymph nodes in colorectal cancer patients. Eur J Surg Oncol 2016; 42(2):260-5.
(39) Khan H, Olszewski A, Somasundar P. Lymph node involvement in colon cancer patients decreases with age; a population based analysis. Eur J Surg Oncol 2014; 40(11):1474-80.
(40) Lee L, Erkan A, Alhassan N, Kelly J, Nassif G, Albert M, et al. Lower survival after right-sided versus left-sided colon cancers: Is an extended lymphadenectomy the answer? Surg Oncol 2018; 27(3):449-55.
(41) Parsons H, Tuttle T, Kuntz K, Begun J, McGovern P, Virnig B. Association between lymph node evaluation for colon cancer and node positivity over the past 20 years. JAMA 2011; 306(10):1089-97.
(42) Budde C, Tsikitis V, Deveney K, Diggs B, Lu K, Herzig D. Increasing the number of lymph nodes examined after colectomy does not improve colon cancer staging. J Am Coll Surg 2014; 218(5):1004-11.
(43) Del Paggio J, Nanji S, Wei X, MacDonald P, Booth C. Lymph node evaluation for colon cancer in routine clinical practice: a population-based study. Curr Oncol 2017; 24(1):e35-e43. doi: 10.3747/co.24.3210.
(44) Kawamura Y, Umetani N, Sunami E, Watanabe T, Masaki T, Muto T. Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement. Eur J Surg 2000; 166(10):803-7.
(45) Canessa C, Badía F, Fierro S, Fiol V, Háyek G. Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum 2001; 44(9):1333-6.
(46) Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J. Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 2011; 98(8):1171-8.
(47) Bertelsen C, Neuenschwander A, Jansen J, Kirkegaard-Klitbo A, Tenma J, Wilhelmsen M, et al. Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg 2016; 103(5):581-9.
(48) Fan Y, Ning F, Zhang C, Dai D. Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: a meta-analysis. Int J Surg 2018; 52:269-77.
(49) Paquette I, Madoff R, Sigurdson E, Chang G. Impact of proximal vascular ligation on survival of patients with colon cancer. Ann Surg Oncol 2018; 25(1):38-45.
(50) Manceau G, Cotte E. Colectomie angulaire gauche vs colectomie subtotale dans les cancers de l’angle colique gauche. Colon Rectum 2017; 11:259–63.
(51) Märkl B, Schaller T, Kokot Y, Endhardt K, Kretsinger H, Hirschbühl K, et al. Lymph node size as a simple prognostic factor in node negative colon cancer and an alternative thesis to stage migration. Am J Surg 2016; 212(4):775-80.
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2020-04-23
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Misa R, Almada M, Brito N, Martínez J, Pouy A, Haro C. Lymph node harvest in colon cancer: Myths and magic. Rev. Méd. Urug. [Internet]. 2020 Apr. 23 [cited 2024 Sep. 16];36(2):177-85. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/533
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