Figure - uploaded by Serkan Karaisli
Content may be subject to copyright.
Factors associated with the lymph node stage and status of lymph node metastasis
Source publication
ABSTRACT
Objective: This study aimed to evaluate the question as to whether there should be a certain length of the colon-rectum segment to be resected for correct lymph node staging in cases with colorectal cancer.
Material and Methods: The files and electronic datas of the patients had been undergone surgery for colorectal cancer between January...
Contexts in source publication
Context 1
... was demonstrated that mean length of the resected colon-rectum and the number of lymph nodes dissected did not affect the presence of metastatic lymph nodes (p= 0.853 and p= 0.088, respectively). Factors associated with the status of lymph node metastasis and lymph node grade are presented in Table 4. Evaluation of the factors associated with the number of dissected lymph nodes demonstrated that it was associated with the number of metastatic lymph nodes (p= 0.003), the mean length of resected colon (p≤ 0.001), tumor size (p≤ 0.001), and distal surgical border (p≤ 0.001). ...Context 2
... was demonstrated that mean length of the resected colon-rectum and the number of lymph nodes dissected did not affect the presence of metastatic lymph nodes (p= 0.853 and p= 0.088, respectively). Factors associated with the status of lymph node metastasis and lymph node grade are presented in Table 4. Evaluation of the factors associated with the number of dissected lymph nodes demonstrated that it was associated with the number of metastatic lymph nodes (p= 0.003), the mean length of resected colon (p≤ 0.001), tumor size (p≤ 0.001), and distal surgical border (p≤ 0.001). ...Similar publications
Background:
Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have g...
Citations
... I 2 =36.98%) (figure 2 and online supplemental figure 22). 51 53 58 63 65-68 Publication bias and sensitivity analysis Sensitivity analysis was performed for all articles (online supplemental figure 10 and online supplemental figures [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Most studies revealed stable results, indicating the reliability of the findings. ...
Objective
Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.
Design
Systematic review and meta-analysis of primary studies.
Data sources
PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.
Eligibility criteria for selecting studies
Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.
Data extraction and synthesis
OR with 95% conference intervals was extracted and pooled.
Results
A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.
Conclusions
The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.
... The prognostic factors that are important for colorectal cancer are the pathological grade of the tumor and the existence of lymph node involvement. Determining the prognostic factors that affect survival, accurate staging and the treatment of choice is important for colorectal cancer [3]. ...
... Currently, the curative treatment option is resection of the tumor with adequate length and margin along with complete dissection of lymph nodes draining the site of resection [3,4]. While a variety of classifications have been used for staging, the TNM staging system is currently used. ...
Objective: The prognostic factors that are important for colorectal cancer are the pathological grade of the tumor and the existence of lymph node involvement. Currently, the curative treatment option is resection of the tumor with adequate length and margin along with complete dissection of lymph nodes draining the site of resection. Our study investigated into retrieving adequate lymph nodes for accurate staging as well as the relationship between lymph nodes and colon and rectum specimen length. Methods: This retrospective cross-sectional study examined the correlation between resected colon length and lymph node count in people with colorectal cancer diagnosed between January 2010 and June 2018. We defined a cutoff value for the segment length to be resected to allow adequate staging of the tumor. Furthermore, we examined the relationship between the resected segment lengths and survival. Results: Of the patients who were included in this study, 211 were men and 169 were women. The mean resected colon length was 26.47±17.09 cm and the mean dissected lymph node count was 29.05±20.84. There was a positive correlation between specimen length and total lymph node count as well as specimen length and the existence of reactive lymph nodes that were statistically significant (r=0.319, p=0.001; r=0.312, p=0.001, respectively). In our study, tumor localization was described in three regions: the right colon, left colon and rectum. The mean right colon region specimen length was 28.8±15.5 cm, while it was 22.0±11.0 cm for the left colon region, and 21.7±10.6 cm for the rectum region. The 5-year overall survival rate was 53.2%, whereas the 5-year disease-specific survival rate was 58.2%. Conclusion: The mean specimen length to achieve the cutoff value for adequate lymph node retrieval (least 12 lymph nodes) was 16 cm in our study (ROC curve, AUC=0.689±0.05, p=0.001). The resected colon length and the number of retrieved lymph nodes were positively correlated in our study. Based on this confirmation, a cutoff value of 16 cm was calculated to achieve an adequate segment length to be resected.
... A combined medial and caudal approach was performed on all patients, which is considered radical approach. 13 -Side to-side anastomosis with a liner cutter stapler was done. In laparoscopic cases, extra-corporeal anastomosis was done by a linear cutter stapler through a transversepara umbilical incision at the port site through which the specimen was extracted. ...
... According to Üreyen et al. (13) revealed if theextent of the excised column is beyond 21 cm or the number of lymph nodes removed is 12 or more, there is no survival advantage. They determined that if performed with oncological surgical uniformity, the excised colonic length can be large. ...
Background:L;ymph node staging is critical for determining the stage of colorectal cancer (CRC). Objective: To see if there was a link between theextent of the resected specimen and count of extracted lymph nodes in hemicolectomypatients and so, the effect of resected specimen length on oncological outcome in right hemicolectomy.Methodology: An observational study.studydone inZagazig University Hospitals from August 2020 to October 2021. It included all patients records who underwent righthemicolectomyfor right colon cancer during this period with inclusion criteria of 26 patients. All patients underwent combined medial and caudal approach right hemicolectomy, 13 patients underwent open right hemicolectomy and 13 patients underwent laparoscopic right hemicolectomy.Results: Using Pearson Correlation Coefficient. We discovered a weak correlation between the number of dissected lymph nodes and the extent of the resected specimen (r = 0.1367, P-Value is.912701). The maximum length of resected colon specimen was 115 cm and associated with 20 extracted lymph nodes. However the minimum length was 20 cm and associated with 46 lymph nodes.Conclusion: The number of harvested lymph nodes in right hemicolectomydepends mainly on oncological resection with radical approach and enough safety surgical margins not on resected specimen length.
... Although there were controversial results concerning the association of the length of resected bowel and the LN yield [1,3,10,11,14,15], some authors also tried to find the cutoff values of specimen lengths for adequate LN counts. They showed that there should be almost < 20 cm of specimen length for sufficient LN counts [22,23]. They evaluated both colon and rectal cancers in their study that can be regarded as a confounding factor. ...
Purpose:
The minimum harvested 12 lymph nodes (LNs) is regarded as the limit for accurate staging of nodal status in colorectal cancer patients. Besides the association of the lengths of resected intestinal segments and vascular pedicles, the mesocolic mesenteric area's impact on LN count has not been studied. We aimed to evaluate the associations between metric variables, including the mesocolic mesentery area on the nodal harvest.
Methods:
All consecutive patients who underwent elective colectomy with a curative intention for colon adenocarcinoma were prospectively included. The metric variables included the lengths of resected intestinal segments, vascular pedicle, and colonic mesenteric area. The variables influencing the LN count and the correlation between the total LN count and the specimens' relevant metric measurements were analyzed.
Results:
There were 46 patients with a median age of 64 years. The median count for total LNs was 22, and the LN positivity was 59.2%. There was an inadequate LN yield (<12) in 3 patients (6.1%). No significant associations were found between the adequacy of nodal harvest and the demographic, clinical, and tumoral features (P>0.05). There were significant positive correlations between total LN number and length of vascular pedicle and mesenteric area (r=0.576, P<0.001 and r=0.566, P<0.001).
Conclusion:
The length of the vascular pedicle and mesenteric area were significantly correlated with total LN counts. Although there was no significant impact on the length of resected segments, the colonic mesenteric area can be used alone as a measure for the assessment of the nodal yield in colon cancer.
AimThe present study was carried out to identify the minimum length of colonic segment that should be removed to ensure adequate lymph node dissection in colorectal cancer.Method
The study involved a retrospective review of 332 patients with stage 1–3 colorectal cancer, who were operated on between 2012 and 2017. Tumour localization, operation type, total length of bowel removed, number of removed lymph nodes and pathological examination results were entered into and analysed using SPSS.ResultsThe number of removed lymph nodes was 12 or lower in 150 of the 332 patients who underwent surgery. Accordingly, the cut-off value for the length of bowel needed to remove at least 12 lymph nodes was studied in 150 patients. The AUC values calculated based on the optimal cut-off values in patients that underwent a right hemicolectomy (21 cm), a laparoscopic right hemicolectomy (31 cm), a laparoscopic left hemicolectomy (16 cm) and a laparoscopic low anterior resection (24 cm) were found to be statistically significant (p<0.05).Conclusion
The minimum length of bowel segment that needs to be removed in order to dissect 12 lymph nodes varies depending on the operation type, being 21 cm for a conventional right hemicolectomy and as high as 31 cm for a laparoscopic right hemicolectomy. The removal of a 16-cm bowel segment will suffice in a laparoscopic left hemicolectomy, while a low anterior resection requires a minimum 24-cm bowel segment to be removed.
