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

Détails

ID Serval
serval:BIB_8D111A96246D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Nodal staging in colorectal cancer: should distant lymph nodes be recovered in surgical specimens?
Périodique
Human Pathology
Auteur(s)
Pusztaszeri M., Matter M., Kuonen A., Bouzourene H.
ISSN
1532-8392
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
40
Numéro
4
Pages
552-557
Langue
anglais
Résumé
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.
Mots-clé
Colorectal Neoplasms, Humans, Lymph Node Excision, Lymphatic Metastasis, Neoplasm Staging, Retrospective Studies
Pubmed
Web of science
Création de la notice
20/05/2009 19:49
Dernière modification de la notice
03/03/2018 19:15
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