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A National Study on Lymph Node Retrieval in Resectional Surgery for Colorectal Cancer

  • Published:
Diseases of the Colon & Rectum

Purpose

This study was designed to develop a mathematical model for predicting the number of lymph nodes harvested in bowel cancer resection specimens based on the current clinical practice in the United Kingdom.

Methods

Prospective clinical data were collected from 8,409 newly diagnosed bowel cancer patients presenting to 79 hospitals in Great Britain and Ireland during a variable 12-month period from 2000 to 2002. A two-level hierarchical regression model was used to identify predictors for lymph node harvest. The model was internally validated by comparing observed and model predicted lymph node harvest for patient subgroups.

Results

Inclusion criteria were satisfied by 5,164 patients. The average lymph node harvest was 11.7 nodes with significant between-center variability in lymph node harvest (range, 5.5–21.3 nodes). Increasing age, American Society of Anesthesiology grade, and preoperative radiotherapy were associated with a reduction of lymph node harvest (P < 0.001). Abdominoperineal resection of the rectum and transverse colectomy were the lowest yield procedures for lymph node harvest. Independent predictors of lymph node harvest were age, American Society of Anesthesiology grade, Dukes stage, operative urgency, type of resection, and preoperative radiotherapy. When tested, the model was found to accurately predict lymph node harvest for group statistics (comparison of observed and model predicted lymph node harvest F1,5154 = 0.63; P = 0.427).

Conclusions

The results of the study suggest that the minimum number of lymph nodes harvested in colorectal cancer surgery cannot be set at a fixed value. The lymph node harvest model provides a simple tool to the frontline clinician for comparing standards between multidisciplinary bowel cancer teams.

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Acknowledgments

The authors thank all the consultants who contributed patients to the study and the data collection officers, managers, audit facilitators for their invaluable assistance. The following hospitals took part in data collection for the ACPGBI study: Ashford & St Peters Hospitals NHS Trust, Belfast Royal Victoria Hospital, Brighton & Sussex University Hospitals NHS Trust, Bro Morgannwg NHS Trust, Calderdale & Huddersfield NHS Trust, Carmarthenshire NHS Trust, Ceredigion & Mid Wales NHS Trust, Chelsea & Westminster Healthcare NHS Trust, City Hospitals Sunderland NHS Trust, Conwy & Denbighshire NHS Trust, County Durham & Darlington Acute Hospitals NHS Trust, Dudley Group Of Hospitals NHS Trust, East & North Hertfordshire NHS Trust, East Sussex Hospitals NHS Trust, Essex Rivers Healthcare NHS Trust, Gateshead Health NHS Trust, Good Hope Hospital NHS Trust, Gwent Healthcare NHS Trust, Harrogate Health Care NHS Trust, Heatherwood & Wexham Park Hospitals NHS Trust, Hereford Hospitals NHS Trust, Homerton University Hospital NHS Trust, James Paget Healthcare NHS Trust, Leeds Teaching Hospitals NHS Trust, Luton & Dunstable Hospital NHS Trust, Mayday Healthcare NHS Trust, Newham Healthcare NHS Trust, North Bristol NHS Trust, North Cumbria Acute Hospitals NHS Trust, North Tees & Hartlepool NHS Trust, Northern Devon Healthcare NHS Trust, Northumbria Health Care NHS Trust, Pembrokeshire & Derwen NHS Trust, Peterborough Hospitals NHS Trust, Poole Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Royal Bournemouth & Christchurch Hospitals NHS Trust, Royal Shrewsbury Hospitals NHS Trust, Royal Surrey County Hospital NHS Trust, Royal West Sussex NHS Trust, Scarborough & North East Yorkshire Health Care NHS Trust, South Devon Health Care NHS Trust, South Manchester University Hospitals NHS Trust, South Tees Hospitals NHS Trust, South Tyneside Health Care NHS Trust, Southport & Ormskirk Hospital NHS Trust, St Helens & Knowsley Hospitals NHS Trust, St Mary’s NHS Trust, Stockport NHS Trust, Swansea NHS Trust, Swindon & Marlborough NHS Trust, The Hammersmith Hospitals NHS Trust, The Lewisham Hospital NHS Trust, The Newcastle Upon Tyne Hospitals NHS Trust, The Whittington Hospital NHS Trust, United Lincolnshire Hospitals NHS Trust, University Hospitals Coventry & Warwickshire NHS Trust, University Hospitals Of Leicester NHS Trust, West Dorset General Hospitals NHS Trust, West Hertfordshire Hospitals NHS Trust, West Suffolk Hospitals NHS Trust, Winchester & Eastleigh Healthcare NHS Trust, Worthing & Southlands Hospitals NHS Trust, Wrightington, Wigan & Leigh NHS Trust, York Health Services NHS Trust.

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary’s Hospital, London, United Kingdom

    Paris P. Tekkis M.D., F.R.C.S., Alexander G. Heriot F.R.C.S. & Ara W. Darzi F.R.C.S.

  2. Department of Surgical Oncology and Technology, Imperial College London, St. Mary’s Hospital, 10th Floor, QEQM Wing, Praed Street, London, W2 1NY, United Kingdom

    Paris P. Tekkis M.D., F.R.C.S.

  3. Department of Surgery, West Middlesex Hospital, Isleworth, United Kingdom

    Jason J. Smith F.R.C.S.

  4. Department of Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom

    Michael R. Thompson F.R.C.S.

  5. Department of Surgery, Princess of Wales Hospital, Bridgend, United Kingdom

    Jeffrey D. Stamatakis F.R.C.S.

Authors
  1. Paris P. Tekkis M.D., F.R.C.S.
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  2. Jason J. Smith F.R.C.S.
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  3. Alexander G. Heriot F.R.C.S.
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  4. Ara W. Darzi F.R.C.S.
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  6. Jeffrey D. Stamatakis F.R.C.S.
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Consortia

On behalf of the Association of Coloproctology of Great Britain and Ireland

Corresponding author

Correspondence to Paris P. Tekkis M.D., F.R.C.S..

Additional information

Supported by the National Clinical Audit Support Programme, (NCASP), United Kingdom.

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Tekkis, P.P., Smith, J.J., Heriot, A.G. et al. A National Study on Lymph Node Retrieval in Resectional Surgery for Colorectal Cancer. Dis Colon Rectum 49, 1673–1683 (2006). https://doi.org/10.1007/s10350-006-0691-2

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  • DOI: https://doi.org/10.1007/s10350-006-0691-2

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