Skip to main content

Advertisement

SpringerLink
Log in

Determinants of Lymph Node Yield and Involvement in Resectable Colon Cancer: A Study of Anatomical, Pathological, and Fresh, Nonfixed Specimen Dissection

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The objective of this study is to assess the success of lymph nodal harvest, extent of nodal spread in pericolic and apical stations, and factors affecting nodal metastasis in freshly resected colon cancer specimens. Following surgery, the lymph nodes were dissected off the specimen in the presence of an onco-pathologist. Apical lymph nodes were stationed according to “Japanese society of nodal classification for colon and rectum,” and pericolic lymph nodes were put into zones, proximally and distally, according to the distances from the tumor epicenter. Pathological analysis was done to see the pattern of nodal spread. Age, sex, T-stage, grade, and lymphovascular invasion (LVI) had no significant association with total lymph nodal yield. The chance of finding positive pericolic lymph nodes within proximal and distal 5 cm (p = 0.002 vs. p = 0.011) and proximal 5 to 10 cm (p = 0.010) of the tumor was significantly high. Beyond 10 cm proximal and 5 cm distal of the tumor epicentre, there were no pericolic positive nodes. Apical lymph nodal harvest rate was 74.64%, and positivity rate was 7% (5 out of 71). T-stage, grade, lymphovascular invasion (LVI), and perineural invasion (PNI) have statistically significant association with pericolic and apical node metastasis. In the fresh colonic specimen, pericolic nodal positivity beyond 10 cm proximal and 5 cm distal of tumor epicenter is rare. Apical and pericolic lymph node positivity is highly dependent upon multiple clinicopathological factors like T-stage, grade, and the presence of LVI and PNI. The lymph nodal yield is much better in fresh specimens by a surgeon under the supervision of a pathologist than fixed specimen. Trial Registered under Clinical Trials Registry-India (CTRI), REF/2019/05/025631.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sung H, Ferlay J et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality for 36 cancers in 185 countries. ACS J CA: A Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660

    Article  Google Scholar 

  2. Bray F, Ferlay J et al (2018) Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  3. The Cancer Genome Atlas Network (2012) Comprehensive molecular characterization of human colon and rectal cancer. Nature 487:330–337

    Article  Google Scholar 

  4. Guinney J, Dienstmann R et al (2015) The consensus molecular subtypes of colorectal cancer. Nat Med 21:1350–1356. https://doi.org/10.1038/nm.3967

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Yaeger R, Chatila WK et al (2018) Clinical sequencing defines the genomic landscape of metastatic colorectal cancer. Cancer Cell 33:125-136.e3. https://doi.org/10.1016/j.ccell.2017.12.004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dienstmann R, Vermeulen L et al (2017) Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer. Nat Rev Cancer 17:79–92. https://doi.org/10.1038/nrc.2016.126

    Article  CAS  PubMed  Google Scholar 

  7. Zhang MR, Chi JL et al (2016) Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis. Oncotarget. 7(45):72898–72907. https://doi.org/10.18632/oncotarget.12131

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ong MLH, Schofield JB (2016) Assessment of lymph node involvement in colorectal cancer. World J Gastrointestinal Surg 8(3):179–192. https://doi.org/10.4240/wjgs.v8.i3.179

    Article  Google Scholar 

  9. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (2019) The 3rd English Edition, Journal of the Anus, Rectum and Colon 3(4):175–195. https://doi.org/10.23922/jarc.2019-018

  10. Tsai HL, Huang C-W et al (2016) Factors affecting number of lymph nodes harvested and the impact of examining a minimum of 12 lymph nodes in stage I-III colorectal cancer patients: a retrospective single institution cohort study of 1167 consecutive patients. BMC Surg. 16:17. https://doi.org/10.1186/s12893-016-0132-7

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hamza A, Sakhi R et al (2018) Role of “second look” lymph node search in harvesting optimal number of lymph nodes for staging of colorectal carcinoma. Gastroenterol Res Practice 2018:6. https://doi.org/10.1155/2018/1985031

    Article  Google Scholar 

  12. Bilimoria KY, Bentrem DJ et al (2008) Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst 100(18):1310–1317. https://doi.org/10.1093/jnci/djn293

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gonen M, Schrag D, Weiser MR (2009) Nodal staging score: a tool to assess adequate staging of node-negative colon cancer. J Clin Oncol. 27(36):6166–6171. https://doi.org/10.1200/JCO.2009.23.7958

    Article  PubMed  PubMed Central  Google Scholar 

  14. Guner OS, Tumay LV (2020) Higher cut-offs for the number of lymph nodes harvested do not predict better prognosis in patients with colon cancer. J Coloproctol 40(4):315–320. https://doi.org/10.1016/j.jcol.2020.06.009

    Article  Google Scholar 

  15. Kazushige Kawai and Teppei Morikawa. (2018) The effect of formalin fixation on the size of pelvic sidewall lymph nodes. International Journal of Colorectal Disease 33(10); June 2018. https://doi.org/10.1007/s00384-018-3103-x.

  16. Chen SL, Bilchik AJ (2006) More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 244(4):602–610. https://doi.org/10.1097/01.sla.0000237655.11717.50

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vather R, Sammour T et al (2009) Lymph node examination as a predictor of long-term outcome in Dukes B colon cancer. Int J Colorectal Dis 24(3):283–288. https://doi.org/10.1007/s00384-008-0540-y

    Article  PubMed  Google Scholar 

  18. Appaiah NNB, Iqbal MR et al (2021) Clinicopathological factors affecting lymph node yield and positivity in left sided colon and rectal cancers. Cureus 13(10):19115. https://doi.org/10.7759/cureus.19115

    Article  Google Scholar 

  19. Yuichiro Tsukada, Masaaki Ito (2022) Japanese D3 dissection in cancer of colon: technique and results. Chapter 12. The lymphatic system of colorectal cancer. 2022;193–214

  20. Hideki Ueno and Kenichi Sugihara (2018) Japanese D3 dissection. Surgical treatment of colon cancer. 259–266. https://doi.org/10.1007/978-981-10-5143-2_23

  21. Glasgow SC, Lowry AC et al (2012) Meta-analysis of histopathological features of primary colorectal cancers that predict lymph node metastases. J Gastrointest Surg. 16(5):1019–1028. https://doi.org/10.1007/s11605-012-1827-4

    Article  PubMed  Google Scholar 

  22. Park IJ, Choi GS et al (2009) Lymph node metastasis patterns in right-sided colon cancers: is segmental resection of these tumors oncologically safe? Ann Surg Oncol 16(6):1501–1506. https://doi.org/10.1245/s10434-009-0368-x

    Article  PubMed  Google Scholar 

  23. Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38(7):705–711. https://doi.org/10.1007/BF02048026

    Article  CAS  PubMed  Google Scholar 

  24. Chin CC, Yeh CY et al (2008) The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer. Int J Colorectal Dis. 23(8):783–788. https://doi.org/10.1007/s00384-008-0465-5

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to record our acknowledgements and thanks to patients and to those who have contributed immensely to making this study as useful and purposeful as possible in its major objectives.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Regional Cancer Center, Thiruvananthapuram, India

    Sandeep Kumar Behera,  Chandramohan. K. & Madhu Muralee

  2. Department of Oncopathology, Regional Cancer Center, Thiruvananthapuram, India

    Renu Sukumaran

  3. Department of Biostatistics, Regional Cancer Center, Thiruvananthapuram, India

    K. M. Jagathnath Krishna

Authors
  1. Sandeep Kumar Behera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chandramohan. K.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Madhu Muralee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Renu Sukumaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. M. Jagathnath Krishna
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design: conceptualization—Dr. Chandramohan K., Dr. Sandeep Kumar Behera, and Dr. Madhu Muralee; methodology—Dr. Chandramohan K. and Dr. Sandeep Kumar Behera; material preparation and data collection—Dr. Sandeep Kumar Behera and Dr. Renu Sughosh; statistical analysis—K. M. Jagannath Krishna and Dr. Sandeep Kumar Behera; first draft of the manuscript written—Dr. Sandeep Kumar Behera; and writing, review, and editing—Dr. Chandramohan K and Dr. Sandeep Kumar Behera.

Corresponding author

Correspondence to Sandeep Kumar Behera.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and scientific research committee.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Behera, S.K., Chandramohan. K., Muralee, M. et al. Determinants of Lymph Node Yield and Involvement in Resectable Colon Cancer: A Study of Anatomical, Pathological, and Fresh, Nonfixed Specimen Dissection. Indian J Surg 85, 1177–1183 (2023). https://doi.org/10.1007/s12262-023-03706-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-023-03706-2

Keywords

Search

Navigation