• Colonic stent
• Colorectal cancer
• Log odds of positive lymph nodes

• Colorectal cancer
• Cox regression analyses
• Lymph nodes
• Overall survival
• T stage

• CME
• GEWF
• Lymph node
• colon cancer
• harvesting
• retrieval

• Vingroup Innovation Foundation (VINIF)

• Learning curve
• Length of stay
• Operative time
• Postoperative complications
• Robotic surgical procedures

• Male
• Adult
• Female
• Humans
• Robotic Surgical Procedures/methods
• Cohort Studies
• Learning Curve
• Prostatectomy/adverse effects
• Hospitals
• Ontario
• Treatment Outcome

• Colorectal carcinoma
• Lymph node harvesting
• Nodal staging

• Humans
• Methylene Blue
• Lymph Nodes/surgery
• Elective Surgical Procedures
• Neoadjuvant Therapy
• Transforming Growth Factor beta
• Colorectal Neoplasms/surgery

• Adenocarcinoma
• Colorectal neoplasms
• Lymph node ratio
• Prognosis
• Survival analysis

• Humans
• Neoplasm Staging
• Lymph Node Ratio
• Lymphatic Metastasis/pathology
• Colorectal Neoplasms/pathology
• Lymph Nodes/pathology
• Prognosis
• Adenocarcinoma/pathology
• Retrospective Studies

• cancer microenvironment
• immunoediting

• Humans
• Lymph Nodes/pathology
• Colorectal Neoplasms/genetics
• Colorectal Neoplasms/surgery
• Colonic Neoplasms/pathology
• Prognosis
• Lymph Node Excision
• Tumor Microenvironment
• Neoplasm Staging

• P30 DK043351 NIDDK NIH HHS

• Lymph nodes
• Neoadjuvant therapy
• Prognosis
• Rectal neoplasms

• Harvested
• Lymph nodes
• NCDB
• Predictors
• Rectal cancer
• Surgery

• Humans
• Male
• Middle Aged
• Aged
• Female
• Retrospective Studies
• Rectal Neoplasms/surgery
• Proctectomy
• Lymph Nodes/surgery
• Lymph Node Excision

• Colon cancer
• Pericolic lymph node
• Regional lymph node
• Tumour-node-metastasis classification

• Colorectal neoplasms
• lymph nodes
• pathology

The aim of this study was to develop and validate a preoperative scoring system to stratify rectal cancer (RC) patients with different risks of inadequate lymph node examination.

A total of 1,375 stage I–III RC patients between 2011 and 2020 from the Second Affiliated Hospital of Harbin Medical University were included in the retrospective study and randomly divided into a development set (n = 688) and a validation set (n = 687). The logistic regression model was used to determine independent factors contributing to lymph node count (LNC) < 12. A preoperative scoring system was constructed based on beta (β) coefficients. The area under the receiver operating curve (AUC) was used to test model discrimination.

Preoperative significant indicators related to LNC < 12 included age, tumor size, tumor location, and CEA. The AUCs of the scoring system for development and validation sets were 0.694 (95% CI = 0.648–0.741) and 0.666 (95% CI = 0.615–0.716), respectively. Patients who scored 0–2, 3–4, and 5–6 were classified into the low-risk group, medium-risk group, and high-risk group, respectively.

The preoperative scoring system could identify RC patients with high risk of inadequate lymphadenectomy accurately and further provide a reference to perform preoperative lymph node staining in targeted patients to reduce the difficulty of meeting the 12-node standard, with the purpose of accurate tumor stage and favorable prognosis.

• Abdominoperineal resection
• Prognostic factor
• Rectal cancer
• Sphincter-saving operation

• Cohort Studies
• Humans
• Neoplasm Recurrence, Local
• Proctectomy
• Propensity Score
• Rectal Neoplasms/pathology
• Retrospective Studies
• Treatment Outcome

The purpose was to examine the effect of negative lymph nodes (NLN) number on survival in stage III colon cancer. To reduce the interference of acute inflammation, we included patients with stage III colon cancer who had undergone elective surgery and excluded those who had tumor perforation, obstruction, ischemia, or massive tumor bleeding.

This retrospective cohort study included 2244 patients with stage III colon cancer between 1995 and 2016 at a single center. The effect of NLN on 5-year relapse-free survival (RFS), 5-year overall survival (OS), and comparison of multivariate factors was assessed according to tumor locations.

The two optimal cutoff values of NLN for proximal and distal colon, namely 27 and 12, were determined by plotting the time-dependent receiver operating characteristic curve. Overall, 499 of 891 and 1020 of 1353 patients with right-side and left-side colon cancer, respectively, had high NLN. In right-side colon cancer, patients with high NLN (≥ 27) had superior OS (74.9% vs. 62.7%, P <  0.001) and RFS (75.0% vs. 61.9%, P <  0.001) than did those with low NLN. Moreover, in left-side colon cancer, patients with high NLN (≥12) experienced significantly superior OS (80.8% vs. 68.6%, P <  0.001) and RFS (77.3% vs. 66.2%, P <  0.001) than did those with low NLN. Among the different subgroups of stage III colon cancer, the high NLN group showed significantly superior RFS and OS in stage IIIB (RFS: 77.0% vs. 68.0%, P = 0.001; OS: 78.6% vs. 67.9%, P <  0.001) and IIIC (RFS: 58.2% vs. 44.1%, P = 0.001; OS: 65.7% vs. 51.1%, P <  0.001) colon cancer. However, in stage IIIA colon cancer, high NLN only showed survival benefit in OS (91.5% vs. 89.8%, P = 0.041). Multivariate analyses confirmed that high NLN, high carcinoembryonic antigen (≥ 5 ng/mL) level, and stage IIIC status are three independent prognostic factors in both the proximal and distal colon.

NLN is a crucial prognostic factor for stage III colon cancer in various tumor locations or in the subgroups of stage III disease. In advanced stage III colon cancer, the importance of NLN and its role in anti-cancer immune response could be highlighted.

• Negative lymph node
• Stage III colon cancer
• Survival
• Tumor location

Background

Colorectal cancer (CRC) is a significant cause of cancer‐related deaths worldwide and is the third most common cause of cancer deaths in the UK. The status of lymph node metastasis is a key factor for predicting the prognosis of a patient's CRC.

Aims

This study aimed to analyze the demographics of left-sided colonic and rectal cancers at a single institution. We looked closely at the correlation between patient age and various histological factors. We tried to find any significant difference in lymph node yield (LNY) between laparoscopic surgery (LS) and open surgery (OS). We aimed to identify any statistical correlation between LNY and lymph node positivity (LNP) with other patient, surgical and histopathological features.

Methodology

This is a retrospective, non-interventional review of consecutive patients who underwent left-sided colonic and rectal cancer resections over a three-year period between 01 April 2018 and 31 March 2021. Descriptive and inferential statistical analyses were used. Chi-squared / Fisher exact test was used on a categorical scale between two or more groups and non-parametric setting for qualitative data analysis.

Results

A total of 102 patients were included in the study. No statistical correlation was found between the age of the patient with the LNY, LNP, location of the tumor, type, and urgency of the operation. LNY ranged between one and 43 nodes (median (interquartile range (IQR)) 17, 8). There was no statistically significant difference in LNY between laparoscopic surgery (LS) and open surgery (OS) (p=0.1449). Significant statistical correlation was identified between LNP and completeness of resection (CoR) (p=0.039), vascular invasion (VI) (p<0.001), perineural invasion (PI) (p<0.001), and circumferential resectional margin involvement (CRMI) (p=0.039).

Discussion

LNY and LNP are important prognostic indices in colorectal cancer. Patient age, tumor location, the urgency of surgery, and consultant experience did not significantly impact the LNY. Our study showed a positive correlation between LNP and CRMI, VI and PI comparable to literature. Contrary to other studies, we found no statistical significance between LS vs. OS and LNY. Whether 12 nodes per patient is an appropriate level remains controversial.

• anterior resection
• colorectal cancer
• crm involvement
• laparoscopic colorectal surgery
• lymph node metastasis
• lymph node status
• lymph node yield
• open colorectal surgery
• perineural invasion
• vascular invasion

Inadequate number of lymph nodes examined was not uncommon. We aimed to assess the clinical role of inadequate number of lymph nodes examined in stage II colon cancer.

The cancer data used in our study were obtained from the SEER (Surveillance, Epidemiology and End Results) program. Using the chi-square test, all the variables obtained in our study were compared based on whether patients had enough (≥12) lymph nodes examined. Kaplan–Meier analysis was used for overall survival (OS) analysis, and log-rank test was applied to compare different N stages with the total number of lymph nodes examined. Multivariate analysis was carried out by creating a Cox proportional hazard model to assess the prognostic roles of different variables.

In total, 80,296 stage II/III colon cancer patients were recruited for our study. N0 stage with <8 lymph nodes examined would present with a worse prognosis compared to N1 stage (5-year OS rates, 51.6% vs. 57.1%, p < 0.001). Multivariate analyses indicated that OS of N0 stage with <8 lymph nodes examined was similar to that of N1 stage after adjusting for other recognized prognostic factors [hazard ratios (HRs) = 1.051, 95% confidence intervals (CIs) = 1.014–1.090, p = 0.018].

N0 stage with less than eight lymph nodes examined in stage II colon cancer presented with no better OS compared to that of N1 stage. Stage II colon cancer with less than eight lymph nodes examined needed to be given greater emphasis in clinical practice.

• lymph nodes
• number
• retrospective
• stage II colon cancer
• survival

• Colon cancer
• Lymph nodes
• Patient outcomes

• Age
• head and neck neoplasm
• lymph node count
• lymphadenectomy
• preoperative radiotherapy, radiation therapy

• Lymph node yield
• Nodal staging
• Right-sided colon cancer
• SEER database
• Survival

• colon cancer
• lymph node examination
• prediction model

This study aimed to identify possible patient- and tumor-related factors associated with risk of TNM stage III disease in nonmetastatic colon cancer.

The associations between stage III disease and age, sex, lymph node yield, pathological tumor (pT) stage, tumor subsite, type of surgery, and priority of surgery were assessed in a nationwide cohort of 13,766 patients treated with curative resection of colon cancer. Each level of age, lymph node yield, and pT stage was compared to the preceding level.

Age, lymph node yield, pT stage, tumor subsite, and priority of surgery were associated with stage III disease. Odds ratios (95% confidence interval [CI]) were as follows: age < 65/65–75 years: 1.28 (95% CI, 1.15–1.43) and 65–75/ > 75 years: 1.22 (95% CI, 1.13–1.32); lymph node yield 0–5/6–11: 0.60 (95% CI, 0.50–0.72), lymph node yield 6–11/12–17: 0.84 (95% CI, 0.76–0.93), and lymph node yield 12–17/ ≥ 18: 0.97 (95% CI, 0.89–1.05); pT1/pT2: 0.74 (95% CI, 0.57–0.95), pT2/pT3: 0.35 (95% CI, 0.30–0.40), and pT3/pT4: 0.49 (95% CI, 0.47–0.54). Only tumors of the transverse colon were independently associated with lower risk of stage III disease than tumors in the sigmoid colon (sigmoid colon: 1, transverse colon: 0.84 [95% CI, 0.73–0.96]; elective surgery: 1, acute surgery: 1.43 [95% CI, 1.29–1.60]).

In this study, stage III disease in colon cancer was significantly associated with age, lymph node yield, pT stage, tumor subsite, and priority of surgery but was not associated with right-sided location compared with stage I and II cancers.

• Colonic neoplasms
• Lymph nodes
• Neoplasm staging
• Tumor subsite

• Adequacy of lymphadenectomy
• CME
• Cancer
• Cancer staging
• Colectomy
• Colorectal
• Colorectal cancer surgery
• Colorectal malignancy
• Lymphadenectomy
• Prognostic factors
• Surgical oncology

• Aged, 80 and over
• Colectomy/methods
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/secondary
• Colorectal Neoplasms/surgery
• Female
• Humans
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Neoplasm Staging
• Postoperative Period
• Prognosis
• Prospective Studies

According to the American Joint Committee on Cancer staging for cancer of the colon, a minimum of 12 lymph nodes (LN) has to be sampled for accurate staging. This has bearing on the long-term prognosis and the need for adjuvant chemotherapy. The aim of this study was to revisit the association of lymph node yield and the long-term survival in patients with stages I and II, i.e. node-negative, colon cancer.

Consecutive patients who underwent elective or emergency curative resections for cancer of colon between the years 2003 and 2012 were retrospectively reviewed. Only patients with stage I or II diseases (AJCC 8th edition) were included. They were analysed in three groups, LN<12, LN12-19 and LN≥20. Their clinic-pathological characteristics were compared. The disease-free (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test.

There was a total of 659 patients included in the analysis. Twelve or more LN were found in 65.6% of the specimens. The mean follow-up was 83.9 months. LN≥20 had significantly better DFS (p = 0.015) and OS (p = 0.036), whereas LN<12 had similar DFS and OS when compared to LN12-19. The advantage in DFS and OS were mainly seen in those with stage II diseases. A lymph node yield of greater than 20 was one of the predictors of favourable DFS, hazard ratio 0.358; 95% CI 0.170–.756, p = 0.007.

The lymph node yield had a significant association with survival outcomes. A lymph node yield of 20 or more was associated with better survival outcomes. On the other hand, lymph node yield less than 12 was not shown to have inferior survival outcomes when compared to those between 12 and 19.

• Colon cancer
• Lymph node
• Survival

• anterior rectal resection
• rectal cancer
• splenic flexure mobilization

• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Anastomotic Leak/etiology
• Anastomotic Leak/prevention & control
• Colectomy/methods
• Colon, Transverse/surgery
• Dissection/methods
• Humans
• Laparoscopy
• Proctectomy/methods
• Rectal Neoplasms/surgery

• Indocyanine green
• colorectal cancer
• preoperative colonoscopic tattooing

Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08 ± 11.4, 20.34 ± 11.8, and 15.33 ± 9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (P = 0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival (P = 0.055, log-rank test). Multiple tumor and patients' factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.

• Colectomy
• Colon cancer
• Lymph node harvest
• Outcomes
• Surgical quality

Lymph node yield (LNY) of 12 or more in resection of colorectal cancer is recommended in current international guidelines. Although a low LNY (less than 12) is associated with poorer outcome in some studies, its prognostic value is unclear in patients with early‐stage colorectal or rectal cancer with a complete pathological response following neoadjuvant therapy. Lymph node ratio (LNR), which reflects the proportion of positive to total nodes obtained, may be more accurate in predicting outcome in stage III colorectal cancer. This study aimed to identify factors correlating with LNY and evaluate the prognostic role of LNY and LNR in colorectal cancer.

An observational study was performed on patients with colorectal cancer treated at three hospitals in Melbourne, Australia, from January 2010 to March 2016. Association of LNY and LNR with clinical variables was analysed using linear regression. Disease‐free (DFS) and overall (OS) survival were investigated with Cox regression and Kaplan–Meier survival analyses.

Some 1585 resections were analysed. Median follow‐up was 27·1 (range 0·1–71) months. Median LNY was 16 (range 0–86), and was lower for rectal cancers, decreased with increasing age, and increased with increasing stage. High LNY (12 or more) was associated with better DFS in colorectal cancer. Subgroup analysis indicated that low LNY was associated with poorer DFS and OS in stage III colonic cancer, but had no effect on DFS and OS in rectal cancer (stages I–III). Higher LNR was predictive of poorer DFS and OS.

Low LNY (less than 12) was predictive of poor DFS in stage III colonic cancer, but was not a factor for stage I or II colonic disease or any rectal cancer. LNR was a predictive factor in DFS and OS in stage III colonic cancer, but influenced DFS only in rectal cancer.

• colorectal neoplasms
• colorectal surgery
• laparoscopy
• lymph node excision
• neoadjuvant therapy

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Laparoscopy/methods
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymphatic Metastasis/pathology
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local/pathology
• Operative Time
• Pelvis
• Pilot Projects
• Rectal Neoplasms/drug therapy
• Rectal Neoplasms/surgery
• Rectum/surgery
• Treatment Outcome

• Colon cancer
• Lymph node
• SEER
• Young patient

• Adult
• Colonic Neoplasms/mortality
• Colonic Neoplasms/pathology
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision/methods
• Lymphatic Metastasis/diagnosis
• Lymphatic Metastasis/pathology
• Male
• Neoplasm Staging/methods
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• SEER Program
• Young Adult

As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.

• colorectal neoplasms
• lymph nodes
• neoplasm staging
• survival analysis

• Early-stage colon cancer
• Lymph node metastases
• Quality assurance
• Screening

• Adult
• Aged
• Colonic Neoplasms/etiology
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Early Detection of Cancer/methods
• Early Detection of Cancer/statistics & numerical data
• Female
• Humans
• Logistic Models
• Lymph Node Excision/statistics & numerical data
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis/diagnosis
• Male
• Medical Audit
• Medical Overuse/statistics & numerical data
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Retrospective Studies
• Risk Factors

• Colon cancer
• Lymph node
• Multivariate analysis
• Prognostic factor
• Rectum cancer

• Aged, 80 and over
• Clinical Decision-Making
• Colonic Neoplasms/surgery
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision
• Lymph Nodes/pathology
• Lymphatic Metastasis/diagnosis
• Male
• Neoplasm Staging/methods
• Prognosis
• SEER Program
• United States

• Colon cancer
• Lymph node yield
• Lymph nodes
• National guidelines

• Age Factors
• Aged
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Denmark
• Female
• Humans
• Logistic Models
• Lymph Nodes/pathology
• Male
• Middle Aged
• Neoplasm Staging
• Prospective Studies

• Aged
• Colorectal neoplasms
• Lymph nodes
• Recurrence

• Anatomy
• Data sets
• NO signaling molecules
• Paradoxical sphincter
• Surgery

There are numerous factors which can affect the lymph node (LN) yield in colon cancer specimens. The aim of this paper was to identify both modifiable and non-modifiable factors that have been demonstrated to affect colonic resection specimen LN yield and to summarise the pertinent literature on these topics. A literature review of PubMed was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens. The terms used for the search were: LN, lymphadenectomy, LN yield, LN harvest, LN number, colon cancer and colorectal cancer. Both non-modifiable and modifiable factors were identified. The review identified fifteen non-surgical factors: (13 non-modifiable, 2 modifiable) which may influence LN yield. LN yield is frequently reduced in older, obese patients and those with male sex and increased in patients with right sided, large, and poorly differentiated tumours. Patient ethnicity and lower socioeconomic class may negatively influence LN yield. Pre-operative tumour tattooing appears to increase LN yield. There are many factors that potentially influence the LN yield, although the strength of the association between the two varies greatly. Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.

• Lymph node
• Number
• Factors
• Yield
• Colon cancer

• Colorectal cancer
• Disease-free survival
• Impact of examining lymph nodes
• Lymph nodes harvested
• Overall survival

• Adult
• Aged
• Colonic Neoplasms/mortality
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Disease-Free Survival
• Female
• Humans
• Lymph Node Excision
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Staging
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Retrospective Studies

• R56 DK105001 NIDDK NIH HHS