International Journal of Colorectal Disease

, Volume 25, Issue 11, pp 1333–1341

Pathological examination of 12 regional lymph nodes and long-term survival in stages I–III colon cancer patients: an analysis of 2,056 consecutive patients in two branches of same institution

  • Hong Hwa Chen
  • Dilip Chakravarty K
  • Jeng-Yi Wang
  • Chung-Rong Changchien
  • Reiping Tang
Original Article

DOI: 10.1007/s00384-010-1020-8

Cite this article as:
Chen, H.H., Chakravarty K, D., Wang, J. et al. Int J Colorectal Dis (2010) 25: 1333. doi:10.1007/s00384-010-1020-8

Abstract

Purpose

Pathologic examination of at least 12 lymph nodes (LNs) is widely accepted as a standard for colon cancer surgery. We sought to address its association with patient source, other clinicopathological factors, and survival by comparing information from two branches in a large single institution.

Methods

Patients with stages I–III adenocarcinoma of the colon between 1998 and 2003 were identified from the Chang Gung Colorectal Tumor Registry in two branches (Linkou and Kaohsiung branches) of same institution. We used multivariate analysis to adjust for variables with P < 0.1 in univariate analyses.

Results

A minimum of 12 examined nodes were observed in 80% of patients in Linkou branch versus 25% in Kaohsiung branch (P < 0.0001). Younger age, right hemicolectomy, larger tumor, higher tumor stage, higher caseload of surgeons, and patients at Linkou branch with an odds ratio (OR) as high as 23 (95% CI, 17–31) were independently associated with a higher frequency of ≥12 examined nodes. Patients with examined node number of <12 had a greater risk of recurrence within stages II and III (stage II: adjusted OR 1.88, 95% CI 1.27–2.79; stage III: adjusted OR 1.58, 95% CI 1.15–2.17) but not within stage I (OR 0.73, 95% CI 0.23–2.24).

Conclusions

The results confirm that factors influencing nodal harvest are multifactorial and the examined LN number of 12 or more is associated with an increased long-term survival in stages II–III colon cancer. It is possible to adequately sample and examine a sufficient number of nodes in the majority of colon cancer specimens by standardized conventional methods.

Keywords

Colon cancerSurvivalOutcomeLymph node harvestTNM

Supplementary material

384_2010_1020_MOESM1_ESM.doc (62 kb)
Table S1(DOC 62 kb)
384_2010_1020_MOESM2_ESM.doc (46 kb)
Table S2(DOC 45 kb)
384_2010_1020_Fig3_ESM.jpg (33 kb)
Fig. S1

(JPEG 33 kb)

384_2010_1020_MOESM3_ESM.tif (134 kb)
High resolution image. (TIFF 134 kb)

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Hong Hwa Chen
    • 1
    • 3
  • Dilip Chakravarty K
    • 2
  • Jeng-Yi Wang
    • 2
    • 3
  • Chung-Rong Changchien
    • 2
    • 3
  • Reiping Tang
    • 2
    • 4
    • 5
  1. 1.Section of Colon and Rectal Surgery, Department of SurgeryChang Gung Memorial HospitalKaohsiungTaiwan
  2. 2.Section of Colon and Rectal Surgery, Department of SurgeryChang Gung Memorial HospitalLinkouTaiwan
  3. 3.College of MedicineChang Gung UniversityTaoyuanTaiwan
  4. 4.School of Traditional Chinese MedicineChang Gung UniversityTaoyuanTaiwan
  5. 5.Section of Colon and Rectal Surgery, Department of SurgeryChang Gung Memorial HospitalTaipeiRepublic of China