Lymph Node Retrieval and Assessment after Colorectal Cancer Resection: Are Pathologists Doing an Adequate Job?
ABSTRACT PURPOSE: Retrieval of the appropriate number of lymph nodes is important in staging colorectal cancer. Inadequate retrieval may result in understaging and inappropriate treatment. This study aimed to examine node retrieval and assessment in colorectal cancer resections performed by a single colorectal surgeon at two different institutions. METHODS: From 2000 to 2005, in a single colorectal surgeon's practice, 123 consecutive patients were identified who were undergoing open colectomies or proctectomies for colorectal cancer. Patients' demographic and surgical data were extracted from records for analysis. RESULTS: Forty patients underwent operations at Hospital A and 83 at Hospital B. No statistical difference in specimen length, tumor size, or stage was found between institutions. For colectomy and proctectomy specimens, Hospital A identified 9.6 and 6.1 nodes and Hospital B, 14.5 and 15 nodes, respectively. Significantly more nodes were identified at Hospital B (P < .001) particularly for proctectomy specimens (P < .001). Only 23 percent of colectomy and 7 percent of proctectomy specimens at Hospital A met American Joint Committee On Cancer guidelines of 12 or more nodes examined, whereas at Hospital B, 63 percent of each specimen type met guidelines (P < 0.05). CONCLUSIONS: Assessment of nodes varied significantly between institutions, which could lead to inadequate treatment. Lymph node retrieval efficiency should be known, and more successful techniques should be standardized.
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ABSTRACT: It has been demonstrated that lymph nodes harvest from surgical specimens of colorectal cancer is one of the most important features for appropriate staging of the disease and to plain the best treatment. The perception of differences in the number of harvest lymph nodes in surgical specimens of colorectal cancer by the same surgeons in different hospitals motivated this investigation. The aims of this study was to assess whether there is difference in the number of lymph nodes and some histopathological features in surgical specimens of colorectal cancer obtained by two surgeons who work both in a university hospital and in a private one. METHODS: We retrospectively evaluated 122 patients, obtaining data on the type of institution (university or private), demographic features, staging, tumor site, histological type, open or laparoscopic access, indication of radiotherapy, number of harvest lymph nodes, presence of vascular, lymphatic and neural invasions. RESULTS: Sixty-five patients were operated in a university institution and 57 in two private institutions. There was no difference between groups in terms of age, stage, tumor site, details of radiotherapy and type of operation. The laparoscopic route was more common in the university institution. The median of lymph nodes harvested was 25 (P25-75: 15-34) in the university institution and 15 in the private ones (P25-75, 12-17) (p <.0001). The finding of 12 or more lymph nodes was more common in academic institution (55/65 versus 40/57, p =. 024). The presence of information of lymphatic, vascular and perineural invasion was more common in the university institution. CONCLUSION: Keeping the same surgical technique and with comparable population of patients, there was considerable difference in the number of lymph nodes harvested between university and private institutions, as like as the report of other relevant data for the histopathological staging, which impacts indication for adjuvant therapies. The relationship between the surgical team and the pathologist should occur in all types of institutions, and the improvement of the quality of the pathological examination should occur in non-university institutions.Revista Brasileira de Coloproctologia 03/2010; 30(1):68-73.
Revista Brasileira de Coloproctologia 01/2010; 30(1). DOI:10.1590/S0101-98802010000100009