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Predictors and survival outcomes of having less than 12 harvested lymph nodes in proctectomy for rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Current recommendations suggest that a minimum of 12 lymph nodes (LNs) should be harvested during curative rectal cancer resection. We aimed to assess predictors and survival outcomes of harvesting < 12 lymph nodes in rectal cancer surgery.

Methods

A retrospective case–control analysis of factors associated with harvesting < 12 LNs in rectal cancer surgery was conducted. Data were derived from the National Cancer Database 2010–2019. Univariate and multivariate binary logistic regression analyses were performed to determine predictors of harvesting < 12 LNs. Association between harvesting < 12 LNs and 5-year overall survival (OS) was assessed using Cox regression and Kaplan Meier statistics.

Results

67,529 patients (60.8% male; mean age: 61.2 ± 12.5 years) were included. Median number of harvested LNs was 15 (IQR: 11–20); 27.1% of patients had < 12 harvested LNs. Independent predictors of harvesting < 12 LNs were older age (OR: 1.016;p < 0.001), neoadjuvant systemic treatment (OR: 1.522;p < 0.001), neoadjuvant radiation treatment (OR: 1.367;p < 0.001), longer duration of radiation therapy (OR: 1.003;p < 0.001) and abdominoperineal resection (OR: 1.071;p = 0.017). Higher clinical TNM stage and tumor grade, pull-through coloanal anastomosis, and minimally invasive surgery were independently associated with ≥ 12 harvested LNs. < 12 harvested LNs was independently associated with lower 5-year OS (HR: 1.24;p < 0.001) and shorter mean OS (96.7 vs 102.8 months;p < 0.001) than ≥ 12 harvested LNs.

Conclusions

Older age, open resection, and neoadjuvant therapy were independent predictors of < 12 harvested LNs. Conversely, higher clinical TNM stage and tumor grade, coloanal anastomosis, and minimally invasive surgery were predictive of ≥ 12 harvested LNs. < 12 LNs harvested was associated with lower OS.

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Data availability

Data used in the study will be available from the first author upon reasonable request.

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Authors and Affiliations

  1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Peige Zhou & Steven D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    Sameh Hany Emile

  3. Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Tel Aviv, Israel

    Nir Horesh

  4. Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel

    Rachel Gefen

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Contributions

Sameh Hany Emile contributed to study design, conception, data processing, analysis and interpretation, and manuscript writing. Nir Horesh, Zoe Garoufalia, Rachel Gefen, Peige Zhou, and Steven D Wexner contributed to data interpretation and critical review of the manuscript.

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Correspondence to Steven D. Wexner.

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Competing interests

None of the authors reports any relevant financial disclosures. Dr. Wexner reports receiving consulting fees from ARC/Corvus, Astellas, Baxter, Becton Dickinson, GI Supply, ICON Language Services, Intuitive Surgical, Leading BioSciences, Livsmed, Medtronic, Olympus Surgical, Stryker, Takeda and receiving royalties from Intuitive Surgical and Karl Storz Endoscopy America Inc. Dr. Emile reports receiving consulting fees from SafeHeal.

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Emile, S.H., Horesh, N., Garoufalia, Z. et al. Predictors and survival outcomes of having less than 12 harvested lymph nodes in proctectomy for rectal cancer. Int J Colorectal Dis 38, 225 (2023). https://doi.org/10.1007/s00384-023-04518-2

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