The Relationship Between the Resected Colon Length and the Number of Lymph Nodes in Colorectal Cancer: A Retrospective Cohort Study
Abstract views: 254 / PDF downloads: 121
DOI:
https://doi.org/10.58600/eurjther1862Keywords:
Colorectal cancer, lymph node, prognosis, colon-rectum length, stageAbstract
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.
Metrics
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394-424. https://doi.org/10.3322/caac.21492
Zhong X, He X, Wang Y, Hu Z, Huang H, Zhao S, Wei P, Li D (2022) Warburg effect in colorectal cancer: the emerging roles in tumor microenvironment and therapeutic implications. J Hematol Oncol 1;15(1):160. https://doi.org/10.1186/s13045-022-01358-5
Üreyen O, Ulusoy C, Acar A, Sağlam F, Kızıloğlu İ, Alemdar A, Atahan KM, Dadalı E, Karaisli S, Aydın MC, İlhan E, Güven H (2020) Should there be a specific length of the colon-rectum segment to be resected for an adequate number of lymph nodes in cases of colorectal cancers? A retrospective multicenter study. Turk J Surg. 18;36(1):23-32. https://doi.org/10.5578/turkjsurg.4550
Hacım NA, Akbaş A, Ulgen Y, Aktokmakyan TV, Meric S, Tokocin M, Karabay O, Altinel Y (2023) Influence of colonic mesenteric area on the number of lymph node retrieval for colon cancer: a prospective cohort study. Ann Coloproctol. 39(1):77-84. https://doi.org/10.3393/ac.2021.00444.0063
Mahmoud NN (2022) Colorectal Cancer: Preoperative Evaluation and Staging. Surg Oncol Clin N Am. 31(2):127-141. https://doi.org/10.1016/j.soc.2021.12.001
O'Connell J, Bennett MW, O'Sullivan GC, Roche D, Kelly J, Collins JK, Shanahan F (1998) Fas ligand expression in primary colon adenocarcinomas: Evidence that the Fas counterattack is prevalent mechanism of immune, evasion in human colon cancer. J Pathol. 186(3):240-6. https://doi.org/10.1002/(SICI)1096-9896(199811)186:3<240::AID-PATH173>3.0.CO;2-L
Elkablawy MA, Maxwell P, Williamson K, Anderson N, Hamilton PW (2001) Apoptosis and cell-cycle regulatory proteins in colorectal carcinoma:Relationship to tumor stage and patient survival. J Pathol. 194(4):436-43. https://doi.org/10.1002/path.894
Mei SW, Liu Z, Wang Z, Pei W, Wei FZ, Chen JN, Wang ZJ, Shen HY, Li J, Zhao FQ, Wang XS, Liu Q (2020) Impact factors of lymph node retrieval on survival in locally advanced rectal cancer with neoadjuvant therapy. World J Clin Cases. 8(24):6229-6242. https://doi.org/10.12998/wjcc.v8.i24.6229
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G (2019) STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int. J. Surg. 72 156–165. https://doi.org/10.1016/j.ijsu.2019.11.002
Orsenigo E, Gasparini G, Carlucci M (2019) Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study, Gastroenterol. Res. Pract. 5197914. https://doi.org/10.1155/2019/5197914
Cianchi F, Palomba A, Boddi V, Messerini L, Pucciani F, Perigli G, Bechi P, Cortesini C (2002) Lymph node recovery from colorectal tumor specimens: recommendation for a minimum number of lymph nodes to be examined. World J Surg. 26(3):384-9. https://doi.org/10.1007/s00268-001-0236-8
Canessa CE, Badía F, Fierro S, Fiol V, Háyek G (2001) Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum. 44(9):1333–1336. https://doi.org/10.1007/BF02234794
Pagès F, Berger A, Camus M, Sanchez-Cabo F, Costes A, Molidor R, Mlecnik B, Kirilovsky A, Nilsson M, Damotte D, Meatchi T, Bruneval P, Cugnenc PH, Trajanoski Z, Fridman WH, Galon J (2005) Effector memory T cells, early metastasis, and survival in colorectal cancer. N. Engl. J. Med. 353(25):2654–2666. https://doi.org/10.1056/NEJMoa051424
Wang L, Hollenbeak CS, Stewart DB (2010) Node yield and node involvement in young colon cancer patients: is there a difference in cancer survival based on age? J Gastrointest Surg. 14(9):1355–1361. https://doi.org/10.1007/s11605-010-1275-y
Steele SR, Chen SL, Stojadinovic A, Nissan A, Zhu K, Peoples GE, Bilchik A (2011) The impact of age on quality measure adherence in colon cancer. J Am Coll Surg. 213(1):95-103; discussion 104-5. https://doi.org/10.1016/j.jamcollsurg.2011.04.013
Patel SS, Nelson R, Sanchez J, Lee W, Uyeno L, Garcia-Aguilar J, Hurria A, Kim J (2013) Elderly patients with colon cancer have unique tumor characteristics and poor survival. Cancer. 119(4)739–747. https://doi.org/10.1002/cncr.27753
Gonsalves WI, Kanuri S, Tashi T, Aldoss I, Sama A, Al-Howaidi I, Ganta A, Kalaiah M, Thota R, Krishnamurthy J, Fang X, Townley P, Ganti AK, Subbiah S, Silberstein PT (2011) Clinicopathologic factors associated with lymph node retrieval in resectable colon cancer: a Veterans’ Affairs Central Cancer Registry (VACCR) database analysis. J Surg Oncol. 104(6):667–671. https://doi.org/10.1002/jso.21886
Parsons HM, Tuttle TM, Kuntz KM, Begun JW, McGovern PM, Virnig BA (2011) Association Between Lymph Node Evaluation for Colon Cancer and Node Positivity Over the Past 20 Years. JAMA. 306(10):1089–1097. https://doi.org/10.1001/jama.2011.1285
Chou JF, Row D, Gonen M, Liu YH, Schrag D, Weiser MR (2010) Clinical and pathologic factors that predict lymph node yield from surgical specimens in colorectal cancer: a population-based study. Cancer. 116(11):2560–2570. https://doi.org/10.1002/cncr.25032
Lavy R, Madjar-Markovitz H, Hershkovitz Y, Sandbank J, Halevy A (2015) Influence of colectomy type and resected specimen length on number of harvested lymph nodes. Int J Surg. 24:91–94. https://doi.org/10.1016/j.ijsu.2015.11.011
Liu Q, Luo D, An H, Zhang S, Cai S, Li Q, Li X (2019) Survival benefit of adjuvant chemotherapy for patients with poorly differentiated stage IIA colon cancer. J Cancer. 10(5):1209–1215. https://doi.org/10.7150/jca.28917
Stracci F, Bianconi F, Leite S, Liso A, La Rosa F, Lancellotta V, van de Velde CJ, Aristei C (2016) Linking surgical specimen length and examined lymph nodes in colorectal cancer patients. Eur J Surg Oncol. 42(2):260–265. https://doi.org/10.1016/j.ejso.2015.11.017
Downloads
Published
How to Cite
License
Copyright (c) 2023 European Journal of Therapeutics
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.