Techniques in Coloproctology

, Volume 12, Issue 4, pp 295–298 | Cite as

Colorectal surgeons and biomedical scientists improve lymph node harvest in colorectal cancer

  • A. ShawEmail author
  • E. E. Collins
  • A. Fakis
  • P. Patel
  • D. Semeraro
  • J. N. Lund
Original Article



The aim of this study was to review lymph node retrieval from colorectal cancer resections.


We examined consecutive, single colorectal cancers excised between September 1999 and February 2007. Data gathered included patient age and gender, cancer location, total number of lymph nodes and involved lymph nodes identified. The speciality of the operating surgeon was recorded. Whether a pathologist or biomedical scientist was responsible for harvesting lymph nodes from the resected specimen was also noted.


A total of 1,194 patients were identified. Increased numbers of lymph nodes identified was associated with increased lymph node positivity (p<0.001, r=0.121). Biomedical scientists identified more lymph nodes (median 15, range 12–20) within specimens than consultant pathologists (median 10, range 7–13; p<0.001). Colorectal surgeons removed more lymph nodes (median 11, range 7–15) than non-colorectal surgeons (median 9, range 7—14; p=0.002).


There was a significant increase in lymph node harvesting over time and this correlated with lymph node positivity. Lymph node harvest was significantly higher when the resection was performed by a colorectal surgeon and when the specimen was examined by a biomedical scientist. For accurate staging and consequent correct planning of adjuvant treatment and prognosis, resections should be performed by a colorectal surgeon and the lymph nodes harvested by a biomedical scientist.

Key words

Lymph Nodes Pathologist Surgeon Harvest Scientist 


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  1. 1.
    Moertel CG, Fleming TR, Macdonald JS et al (1990) Levamisole and fluorouracil for adjuvant therapy of resected colon cancer. N Engl J Med 322:352–358PubMedGoogle Scholar
  2. 2.
    Wong JH, Johnson DS, Hemmings D et al (2005) Assessing the quality of colorectal cancer staging: documenting the process in improving the staging of node-negative colorectal cancer. Arch Surg 140:881–887PubMedCrossRefGoogle Scholar
  3. 3.
    Greene FL, Stewart AK, Norton HJ (2002) A new TNM staging strategy for node positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg 236:416–421PubMedCrossRefGoogle Scholar
  4. 4.
    Dukes CE, Bussey HJR (1958) The spread of rectal cancer and its effect on prognosis. Br J Surg 12:309–320Google Scholar
  5. 5.
    Wolmark N, Rockette H, Fisher B et al (1993) The benefit of leucovorin-modulated fluorouracil as postoperative therapy for primary colon cancers: results from the National Surgical Adjuvant Breast and Bowel Project. J Clin Oncol 11:1879–1887PubMedGoogle Scholar
  6. 6.
    National Institute for Health and Clinical Excellence (2004) Improving outcomes in colorectal cancers: manual update. National Institute for Health and Clinical Excellence, London.
  7. 7.
    Greenson JK, Isenhart CE, Rice R et al (1994) Identification of occult micrometastases in pericolic lymph nodes of Dukes B colorectal cancer patients using monoclonal antibodies again cytokeratin and CC49. Cancer 73:563–569PubMedCrossRefGoogle Scholar
  8. 8.
    Scott KWM, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167PubMedCrossRefGoogle Scholar
  9. 9.
    Fielding LP, Arsenault PA, Chapuis PH et al (1991) Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol 6:325–344PubMedCrossRefGoogle Scholar
  10. 10.
    Goldstein NS, Weldon S, Coffey M, Layfield LJ (1996) Lymph node recovery from colorectal resection specimens removed for adenocarcinoma: trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 106:209–216PubMedGoogle Scholar
  11. 11.
    Fielding LP (1988) Clinico-pathologic staging of large-bowel cancer: a report of the ASCRS Committee. Dis Colon Rectum 31:204–209PubMedCrossRefGoogle Scholar
  12. 12.
    Wong JH, Severino R, Honnebier MB et al (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900PubMedGoogle Scholar
  13. 13.
    Newland RC, Chapius PH, Smythe EJ (1987) The prognostic value of substaging colorectal carcinoma: a prospective study of 1117 cases with standardized pathology. Cancer 60:852–857PubMedCrossRefGoogle Scholar
  14. 14.
    Cawthorn SJ, Gibbs NM, Marks CG (1986) Clearance technique for the detection of lymph nodes in colorectal cancer. Br J Surg 73:58–60PubMedCrossRefGoogle Scholar
  15. 15.
    Herrera L, Villareal JR (1992) Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique. Dis Colon Rectum 35:783–788PubMedCrossRefGoogle Scholar
  16. 16.
    Haboubi NY, Clark P, Kaftan SM, Schofield PF (1992) The importance of combining xylene clearance and immunohistochemistry in the accurate staging of colorectal carcinoma. J R Soc Med 85:386–388PubMedGoogle Scholar
  17. 17.
    Evans M, Robinson S, Rees A et al (2008) Same surgeon — different centre equals different lymph node harvest. ASCRS Meeting Abstracts. Dis Colon Rectum 51:176Google Scholar
  18. 18.
    Lerut T (2000) The surgeon as a prognostic factor. Ann Surg 232:729–732PubMedCrossRefGoogle Scholar
  19. 19.
    Porter G, Soskolne C, Yakimets W, Newman S (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227:157–167PubMedCrossRefGoogle Scholar
  20. 20.
    Read T, Myerson R, Fleshman J et al (2002) Surgeon speciality is associated with outcome in rectal cancer surgery. Dis Colon Rectum 45:901–914Google Scholar
  21. 21.
    Phillips RK, Hittinger R, Blesovsky L et al (1984). Local recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture. Br J Surg 71:12–16PubMedCrossRefGoogle Scholar
  22. 22.
    Dorrance HR, Docherty GM, O’Dwyer PJ (2000) Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery. Dis Colon Rectum 43:492–498PubMedCrossRefGoogle Scholar
  23. 23.
    Hermanek P, Wiebelt H, Staimmer D, Riedl S (1995) Prognostic factors of rectum carcinoma — experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma. Tumori 81[3 Suppl]:60–64PubMedGoogle Scholar
  24. 24.
    Holm T, Johansson H, Cedermark B et al (1997) Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 84:657–663PubMedCrossRefGoogle Scholar
  25. 25.
    Kockerling F, Reymond MA, Altendorf-Hofmann A et al (1998) Influence of surgery on metachronous distant metastases and survival in rectal cancer. J Clin Oncol 16:324–329PubMedGoogle Scholar
  26. 26.
    Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRefGoogle Scholar
  27. 27.
    Schoetz DJ (1998) Colon and rectal surgery: a true subspecialty. Dis Colon Rectum 41:1–10PubMedCrossRefGoogle Scholar
  28. 28.
    Tekkis PP, Smith JJ, Heriot AG et al (2006) A national survey on lymph node retrieval in resectional surgery for colorectal cancer. Dis Colon Rectum 49:1673–1683PubMedCrossRefGoogle Scholar
  29. 29.
    Goldstein ET (1996) Outcomes of anorectal disease in a health maintenance organization setting: the need for colorectal surgeons. Dis Colon Rectum 39:1193–1198PubMedCrossRefGoogle Scholar
  30. 30.
    Cameron JL (1993) Is fellowship training in alimentary tract surgery necessary? Am J Surg 165:2–8PubMedCrossRefGoogle Scholar
  31. 31.
    Rosen L, Stasik JJ Jr, Reed JF III et al (1996) Variations in colon and rectal surgical mortality: comparison of specialties with a state-legislated database. Dis Colon Rectum 39:129–135PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • A. Shaw
    • 1
    Email author
  • E. E. Collins
    • 1
  • A. Fakis
    • 2
  • P. Patel
    • 3
  • D. Semeraro
    • 3
  • J. N. Lund
    • 1
  1. 1.School of Graduate Entry Medicine and HealthUniversity of NottinghamDerbyUK
  2. 2.Department of Research and DevelopmentDerby Hospitals NHS Foundation TrustDerbyUK
  3. 3.Department of HistopathologyDerby City General HospitalDerbyUK

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