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Techniques in Coloproctology

, Volume 18, Issue 8, pp 709–717 | Cite as

Establishing the optimum lymph node yield for diagnosis of stage III rectal cancer

  • A. BhanguEmail author
  • R. P. Kiran
  • G. Brown
  • R. Goldin
  • P. Tekkis
Original Article

Abstract

Background

The optimum lymph node yield for tumour staging following surgery for rectal cancer remains controversial. This study aimed to determine the optimum number of lymph nodes needed to accurately determine stage III rectal cancer.

Methods

Sixty-three thousand three hundred and eighty-one patients from the surveillance, epidemiology and end resulted database, who underwent surgery for rectal adenocarcinoma in 1995–2009, were included. The primary outcome was detection of stage III rectal cancer, assessed by multivariable logistic regression.

Results

Each additional node examined increased the chance of stage III diagnosis by 3.9 % (adjusted odds ratio 1.039, p < 0.001). Optimum histopathological stage was reached following retrieval of 18 nodes in patients treated without neoadjuvant radiotherapy (n = 49,162) and 16 nodes in those treated with neoadjuvant radiotherapy (n = 14,219). For stage I and II cancer, retrieval of a minimum of 8 and 14 nodes, respectively, was associated with optimum five-year overall survival. For stage III cancer, increasing number of positive lymph nodes and increasing lymph node ratio (>0.5) were independent negative predictors of survival; total lymph node yield did not correlate with survival.

Conclusions

Eighteen lymph nodes for those treated without neoadjuvant radiotherapy and 16 nodes for those treated with it were needed to prevent stage migration in rectal cancer. These findings provide further evidence of the importance of the technique of proctectomy and of careful pathologic assessment.

Keywords

Rectal cancer Staging Lymph node yield Lymph node ratio SEER 

Notes

Conflict of interest

None.

Supplementary material

10151_2013_1114_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 kb)

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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • A. Bhangu
    • 1
    • 2
    Email author
  • R. P. Kiran
    • 3
  • G. Brown
    • 4
  • R. Goldin
    • 5
  • P. Tekkis
    • 1
    • 2
  1. 1.Division of Colorectal SurgeryRoyal Marsden HospitalLondonUK
  2. 2.Division of SurgeryImperial CollegeLondonUK
  3. 3.Division of Colorectal Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew YorkUSA
  4. 4.Department of RadiologyThe Royal Marsden HospitalLondonUK
  5. 5.Centre for PathologyImperial College, St. Mary’s HospitalLondonUK

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