Increased lymph node evaluation with colorectal cancer resection

Does it improve detection of stage III disease?

Sachin S. Kukreja, Enrique Esteban-Agusti, Josè M. Velasco, Tina J Hieken

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Hypothesis: Evaluation of 12 or more lymph nodes (LNs) with colorectal cancer (CRC) resection may not improve detection of stage III disease. Design: Retrospective review after intervention. Setting: Community teaching hospital. Patients: We evaluated 701 consecutive operative CRC cases ascertained from our Cancer Registry. Intervention: Patients undergoing resection before (n=553) a multidisciplinary initiative emphasizing the importance of LN counts were compared with those undergoing operation afterward (n=148). Main Outcome Measures: Number of LNs evaluated, proportion of patients with stage III disease, and proportion of patients with N1 vs N2 disease. Results: Demographic, tumor, and treatment variables were similar for both groups, except for younger age, fewer white patients, and more laparoscopic resections in the late period. Lymphnode counts increased from a mean (SEM [median]) of 12.8 (0.3 [12]) to 17.3 (0.7 [16]) (P < .001), with 53.0% of the early vs 71.6% of the late patients having at least 12 LNs examined. The proportion diagnosed as having stage IIICRCwas 204 of 553 (36.9%) for the early group vs 48 of 148 (32.4%) for the late group (P=.31). Among patients with positive LNs, the distribution of N1 and N2 disease was unchanged (early, 50.5% N1 and 49.5% N2; late, 54.2% N1 and 45.8% N2; P=.54). Conclusions: Increased LN retrieval does not identify a greater number of patients with stage III CRC nor does it increase the proportion of patients with positive LNs with N2 disease. Our data suggest that harvest of at least 12 LNs as a quality or performance measure appears unfounded.

Original languageEnglish (US)
Pages (from-to)612-616
Number of pages5
JournalArchives of Surgery
Volume144
Issue number7
DOIs
StatePublished - Jul 2009
Externally publishedYes

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Colorectal Neoplasms
Lymph Nodes
Community Hospital
Teaching Hospitals
Registries
Neoplasms
Demography
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

Increased lymph node evaluation with colorectal cancer resection : Does it improve detection of stage III disease? / Kukreja, Sachin S.; Esteban-Agusti, Enrique; Velasco, Josè M.; Hieken, Tina J.

In: Archives of Surgery, Vol. 144, No. 7, 07.2009, p. 612-616.

Research output: Contribution to journalArticle

Kukreja, Sachin S. ; Esteban-Agusti, Enrique ; Velasco, Josè M. ; Hieken, Tina J. / Increased lymph node evaluation with colorectal cancer resection : Does it improve detection of stage III disease?. In: Archives of Surgery. 2009 ; Vol. 144, No. 7. pp. 612-616.
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abstract = "Hypothesis: Evaluation of 12 or more lymph nodes (LNs) with colorectal cancer (CRC) resection may not improve detection of stage III disease. Design: Retrospective review after intervention. Setting: Community teaching hospital. Patients: We evaluated 701 consecutive operative CRC cases ascertained from our Cancer Registry. Intervention: Patients undergoing resection before (n=553) a multidisciplinary initiative emphasizing the importance of LN counts were compared with those undergoing operation afterward (n=148). Main Outcome Measures: Number of LNs evaluated, proportion of patients with stage III disease, and proportion of patients with N1 vs N2 disease. Results: Demographic, tumor, and treatment variables were similar for both groups, except for younger age, fewer white patients, and more laparoscopic resections in the late period. Lymphnode counts increased from a mean (SEM [median]) of 12.8 (0.3 [12]) to 17.3 (0.7 [16]) (P < .001), with 53.0{\%} of the early vs 71.6{\%} of the late patients having at least 12 LNs examined. The proportion diagnosed as having stage IIICRCwas 204 of 553 (36.9{\%}) for the early group vs 48 of 148 (32.4{\%}) for the late group (P=.31). Among patients with positive LNs, the distribution of N1 and N2 disease was unchanged (early, 50.5{\%} N1 and 49.5{\%} N2; late, 54.2{\%} N1 and 45.8{\%} N2; P=.54). Conclusions: Increased LN retrieval does not identify a greater number of patients with stage III CRC nor does it increase the proportion of patients with positive LNs with N2 disease. Our data suggest that harvest of at least 12 LNs as a quality or performance measure appears unfounded.",
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