Nodal staging in colorectal cancer: should distant lymph nodes be recovered in surgical specimens?

Human Pathology
Marc PusztaszeriHanifa Bouzourene

Abstract

To assess the value of sampling lymph nodes located far sidelong colorectal cancer specimens, we analyzed retrospectively surgical specimens from 345 colorectal cancer patients. The mesocolic and perirectal fat was divided into 2 fractions: close to (<5 cm) and distant from (>5 cm) the tumor. Tumors were located in the cecum (n = 61), ascending colon (n = 29), transverse colon (n = 31), descending colon (n = 27), sigmoid colon (n = 108), and rectum (n = 89). The median number of lymph nodes sampled was 17 in both fractions (range, 4-66), 12 (range, 0-46) in the close fraction, and 3 (range, 0-33) in the distant fraction. There were 169 pN0, 104 pN1, and 72 pN2 cases. The pN staging was accurate in all cases except 10 based on the close fraction alone; of these, 6 were upstaged from pN0 to pN1 and 4 from pN1 to pN2 when the distant fraction was considered. Among pN1-upstaged cases, 5 were rectal (3/5 with neoadjuvant radiotherapy) and 1 colonic. In the colon, we found that lymph node location is more important than lymph node number because metastatic lymph nodes were present mostly in the peritumoral area. This suggests that lymph nodes should be initially recovered from the pericolic fat close to the tumor. If there are less t...Continue Reading

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Citations

Aug 14, 2009·International Journal of Cancer. Journal International Du Cancer·Fania S DoekhieRob A Tollenaar
Sep 30, 2016·Archives of Pathology & Laboratory Medicine·Mikhail LisovskyAmitabh Srivastava
Feb 25, 2017·International Journal of Cancer. Journal International Du Cancer·Chandra KiranaEhud Hauben
Mar 24, 2011·International Journal of Surgical Pathology·Jatinder S Minhas, Laszlo Igali
Apr 25, 2012·World Journal of Surgery·Jae Young KwakJin Cheon Kim
May 9, 2013·World Journal of Surgery·Jamie Murphy, Tonia Young-Fadok

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