Current Colorectal Cancer Reports

, Volume 4, Issue 4, pp 211–217 | Cite as

Lymph node sampling for rectal cancer: How much is enough?



Current guidelines recommend that at least 12 lymph nodes should be evaluated during colon cancer resection in order to ensure adequate staging. However, the minimum number of lymph nodes that should be assessed in curative treatment for rectal cancer has yet to be defined, and a 12 lymph node minimum may not be generalizable to this group of patients. Accurate nodal staging in rectal cancer is further complicated by the use of preoperative chemoradiation in locally advanced disease, which has been associated with a decrease in the number of identifiable lymph nodes. The number of lymph nodes evaluated in patients with rectal cancer affects staging and prognosis; however, further study is warranted before standards for a minimum number of lymph nodes that should be examined can be firmly established.


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References and Recommended Reading

  1. 1.
    Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2007. CA Cancer J Clin 2007, 57:43–66.PubMedGoogle Scholar
  2. 2.
    Nelson H, Petrelli N, Carlin A, et al.: Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001, 93:583–596.PubMedCrossRefGoogle Scholar
  3. 3.
    American Cancer Society: Staging colorectal cancer. Available at Accessed June 20, 2008.
  4. 4.
    Baxter NN, Virnig DJ, Rothenberger DA, et al.: Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005, 97:219–225.PubMedCrossRefGoogle Scholar
  5. 5.
    Pagès F, Berger A, Camus M, et al.: Effector memory T cells, early metastasis, and survival in colorectal cancer. N Engl J Med 2005, 353:2654–2666.PubMedCrossRefGoogle Scholar
  6. 6.
    Görög D, Nagy P, Péter A, Perner F: Influence of obesity on lymph node recovery from rectal resection specimens. Pathol Oncol Res 2003, 9:180–183.PubMedCrossRefGoogle Scholar
  7. 7.
    Ostadi MA, Harnish JL, Stegienko S, Urbach DR: Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens. Surg Endosc 2007, 21:2142–2146.PubMedCrossRefGoogle Scholar
  8. 8.
    Scott KW, Grace RH: Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989, 76:1165–1167.PubMedCrossRefGoogle Scholar
  9. 9.
    Fielding LP, Arsenault PA, Chapuis PH, et al.: Clinico-pathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol 1991, 6:325–344.PubMedCrossRefGoogle Scholar
  10. 10.
    Compton CC, Fielding LP, Burgart LJ, et al.: Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000, 124:979–994.PubMedGoogle Scholar
  11. 11.
    Caplin S, Cerottini JP, Bosman FT, et al.: For patients with Dukes’ B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer 1998, 83:666–672.PubMedCrossRefGoogle Scholar
  12. 12.
    Goldstein NS, Sanford W, Coffey M, Layfield LJ: 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 1996, 106:209–216.PubMedGoogle Scholar
  13. 13.
    Ratto C, Sofo L, Ippoliti M, et al.: Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significance. Dis Colon Rectum 1999, 42:143–154.PubMedCrossRefGoogle Scholar
  14. 14.
    Wong SL, Ji H, Hollenbeck BK, et al.: Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 2007, 298:2149–2154.PubMedCrossRefGoogle Scholar
  15. 15.
    Le Voyer TE, Sigurdson ER, Hanlon AL, et al.: Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 2003, 21:2912–2919.PubMedCrossRefGoogle Scholar
  16. 16.
    Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA: Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007, 99:433–441.PubMedCrossRefGoogle Scholar
  17. 17.
    Chen SL, Bilchik AJ: More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 2006, 244:602–610.PubMedGoogle Scholar
  18. 18.
    Andreola S, Leo E, Belli F, et al.: Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm. Cancer 1996, 77:607–612.PubMedCrossRefGoogle Scholar
  19. 19.
    Dworák O: Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc 1989, 3:96–99.PubMedCrossRefGoogle Scholar
  20. 20.
    Fajardo LF: Effects of ionizing radiation on lymph nodes. A review. Front Radiat Ther Oncol 1994, 28:37–45.PubMedGoogle Scholar
  21. 21.
    Herrera L, Villarreal JR: Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique. Dis Colon Rectum 1992, 35:783–788.PubMedCrossRefGoogle Scholar
  22. 22.
    Sanchez W, Luna-Perez P, Alvarado I, et al.: Modified clearing technique to identify lymph node metastases in post-irradiated surgical specimens from rectal adenocarcinoma. Arch Med Res 1996, 27:31–36.PubMedGoogle Scholar
  23. 23.
    Tepper JE, O’Connell MJ, Niedzwiecki D, et al.: Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001, 19:157–163.PubMedGoogle Scholar
  24. 24.
    Murphy J, Pocard M, Jass JR, et al.: Number and size of lymph nodes recovered from dukes B rectal cancers: correlation with prognosis and histologic antitumor immune response. Dis Colon Rectum 2007, 50:1526–1534.PubMedCrossRefGoogle Scholar
  25. 25.
    Stocchi L, Nelson H, Sargent DJ, et al.: Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol 2001, 19:3895–3902.PubMedGoogle Scholar
  26. 26.
    Thorn CC, Woodcock NP, Scott N, et al.: What factors affect lymph node yield in surgery for rectal cancer? Colorectal Dis 2004, 6:356–361.PubMedCrossRefGoogle Scholar
  27. 27.
    Glynne-Jones R, Wallace M, Livingstone JI, Meyrick-Thomas J: Complete clinical response after preoperative chemoradiation in rectal cancer: is a “wait and see” policy justified? Dis Colon Rectum 2008, 51:10–19.PubMedCrossRefGoogle Scholar
  28. 28.
    Rullier A, Laurent C, Capdepont M, et al.: Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol 2008, 32:45–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Wichmann MW, Müller C, Meyer G, et al.: Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg 2002, 137:206–210.PubMedCrossRefGoogle Scholar
  30. 30.
    Maschuw K, Kress R, Ramaswamy A, et al.: Short-term preoperative radiotherapy in rectal cancer patients leads to a reduction of the detectable number of lymph nodes in resection specimens. Langenbecks Arch Surg 2006, 391:364–368.PubMedCrossRefGoogle Scholar
  31. 31.
    Baxter NN, Morris AM, Rothenberger DA, Tepper JE: Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys 2005, 61:426–431.PubMedGoogle Scholar
  32. 32.
    Beresford M, Glynne-Jones R, Richman P, et al.: The reliability of lymph-node staging in rectal cancer after preoperative chemoradiotherapy. Clin Oncol (R Coll Radiol) 2005, 17:448–455.Google Scholar
  33. 33.
    Luna-Pérez P, Bustos-Cholico E, Alvarado I, et al.: Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection. J Surg Oncol 2005, 90:20–25.PubMedCrossRefGoogle Scholar
  34. 34.
    Habr-Gama A, Perez RO, Proscurshim I, et al.: Absence of lymph nodes in the resected specimen after radical surgery for distal rectal cancer and neoadjuvant chemoradiation therapy: what does it mean? Dis Colon Rectum 2008, 51:277–283.PubMedCrossRefGoogle Scholar
  35. 35.
    Chang GJ, Rodriguez-Bigas MA, Eng C, Skibber JM: Pathologic N-stage after preoperative radiotherapy predicts prognosis in rectal cancer. Gastrointestinal Cancers Symposium of the American Society of Clinical Oncology, 2007. Abstract 338.Google Scholar
  36. 36.
    den Dulk M, Collette L, van de Velde CJ, et al.: Quality of surgery in T3–4 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Results from EORTC trial 22921. Eur J Cancer 2007, 43:1821–1828.CrossRefGoogle Scholar
  37. 37.
    Kapiteijn E, Kranenbarg EK, Steup WH, et al.: Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer. Prospective randomised trial with standard operative and histopathological techniques. Dutch ColoRectal Cancer Group. Eur J Surg 1999, 165:410–420.PubMedCrossRefGoogle Scholar
  38. 38.
    Pocard M, Panis Y, Malassagne B, et al.: Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum 1998, 41:839–845.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Surgical OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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