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World J Gastrointest Oncol. May 15, 2016; 8(5): 466-473
Published online May 15, 2016. doi: 10.4251/wjgo.v8.i5.466
Non-surgical factors influencing lymph node yield in colon cancer
Patrick Wood, Colin Peirce, Jurgen Mulsow
Patrick Wood, Colin Peirce, Jurgen Mulsow, Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
Author contributions: Wood P, Peirce C and Mulsow J contributed equally to this work; Wood P, Peirce C and Mulsow J analysed data; Wood P and Peirce C performed the research and wrote the paper; Peirce C and Mulsow J designed the research.
Conflict-of-interest statement: The authors of this paper have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jurgen Mulsow, Consultant Colorectal Surgeon, Department of Colorectal Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. jmulsow@mater.ie
Telephone: +353-1-8545091 Fax: +353-1-8034023
Received: September 29, 2015
Peer-review started: October 1, 2015
First decision: November 13, 2015
Revised: December 15, 2015
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 15, 2016
Processing time: 223 Days and 18.1 Hours
Abstract

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.

Keywords: Lymph node; Number; Factors; Yield; Colon cancer

Core tip: Surgeons, pathologists and patients alike must appreciate that there are many factors which influence lymph node (LN) yield in resected colon cancer specimens. Clinicians must strive for the perfect oncological operation and pathological analysis. However, clinicians should be aware that despite optimal surgery and pathological analysis, other factors may influence the LN yield following colonic resection for cancer.