Nodal staging in colorectal cancer: should distant lymph nodes be recovered in surgical specimens?

Details

Serval ID
serval:BIB_8D111A96246D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Nodal staging in colorectal cancer: should distant lymph nodes be recovered in surgical specimens?
Journal
Human Pathology
Author(s)
Pusztaszeri M., Matter M., Kuonen A., Bouzourene H.
ISSN
1532-8392
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
40
Number
4
Pages
552-557
Language
english
Abstract
To assess the value of sampling lymph nodes located far sidelong colorectal cancer specimens, we analyzed retrospectively surgical specimens from 345 colorectal cancer patients. The mesocolic and perirectal fat was divided into 2 fractions: close to (<5 cm) and distant from (>5 cm) the tumor. Tumors were located in the cecum (n = 61), ascending colon (n = 29), transverse colon (n = 31), descending colon (n = 27), sigmoid colon (n = 108), and rectum (n = 89). The median number of lymph nodes sampled was 17 in both fractions (range, 4-66), 12 (range, 0-46) in the close fraction, and 3 (range, 0-33) in the distant fraction. There were 169 pN0, 104 pN1, and 72 pN2 cases. The pN staging was accurate in all cases except 10 based on the close fraction alone; of these, 6 were upstaged from pN0 to pN1 and 4 from pN1 to pN2 when the distant fraction was considered. Among pN1-upstaged cases, 5 were rectal (3/5 with neoadjuvant radiotherapy) and 1 colonic. In the colon, we found that lymph node location is more important than lymph node number because metastatic lymph nodes were present mostly in the peritumoral area. This suggests that lymph nodes should be initially recovered from the pericolic fat close to the tumor. If there are less than 4 positive lymph nodes and less than 12 lymph nodes examined in total, additional lymph nodes should be retrieved from the distal fraction for potential upstaging. In the rectum, systematic sampling of close and distant lymph nodes is mandatory because in rare cases, metastases are detected only in distant lymph nodes, particularly in patients who have undergone neoadjuvant radiotherapy.
Keywords
Colorectal Neoplasms, Humans, Lymph Node Excision, Lymphatic Metastasis, Neoplasm Staging, Retrospective Studies
Pubmed
Web of science
Create date
20/05/2009 19:49
Last modification date
20/08/2019 15:51
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