The Relationship Between the Resected Colon Length and the Number of Lymph Nodes in Colorectal Cancer: A Retrospective Cohort Study

Abstract views: 172 / PDF downloads: 59




Colorectal cancer, lymph node, prognosis, colon-rectum length, stage


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 Loading ...


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.

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.

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.

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.

Mahmoud NN (2022) Colorectal Cancer: Preoperative Evaluation and Staging. Surg Oncol Clin N Am. 31(2):127-141.

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.<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.

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.

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.

Orsenigo E, Gasparini G, Carlucci M (2019) Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study, Gastroenterol. Res. Pract. 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Figure 1




How to Cite

Karabay, U., Yılmaz, L., Aytekin, A., & Bulut, A. (2023). The Relationship Between the Resected Colon Length and the Number of Lymph Nodes in Colorectal Cancer: A Retrospective Cohort Study. European Journal of Therapeutics, 29(4), 731–740.



Original Articles