Impact of lymph node retrieval and pathological ultra-staging on the prognosis of stage II colon cancer

• Published in: Journal of surgical oncology Vol. 84; no. 3; pp. 120 - 126
• Main Authors: Law, Calvin H.L., Wright, Frances C., Rapanos, Theodore, Alzahrani, Mohamed, Hanna, Sherif S., Khalifa, Mahmoud, Smith, Andrew J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.11.2003; Wiley-Liss
• Subjects: Aged; Biological and medical sciences; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; curative surgery; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Lymph Nodes - blood supply; Lymph Nodes - pathology; Lymphatic Metastasis; lymphovascular invasion; Male; Medical sciences; micrometastases; Neoplasm Invasiveness; Neoplasm Metastasis - pathology; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging - methods; pathology; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Retrospective Studies; staging; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; survival; Survival Rate; Treatment Outcome; Tumors; Prognosis; pathology; Surgery; Cohort study; Decision aid; Micrometastasis; Intestinal disease; Colon; staging; Survival curve; Quantitative analysis; Human; Lymph node; Space occupying lesion; micrometastases; Stage classification; survival; Surgical resection; Malignant tumor; Colonic disease; Sensitivity; Treatment; lymphovascular invasion; curative surgery; Digestive diseases
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.10309

Background and Objectives A minimum number of lymph nodes must be assessed for accurate diagnosis of stage II colon cancer. We assessed number of lymph nodes retrieved, pathological ultra‐staging, and outcome in stage II colon cancer. Materials and Methods Consecutively treated patients with stage II colon cancer were identified. Baseline and outcome data were collected. Retrospective ultra‐staging using lymphovascular invasion (LVI) and nodal micrometastases was performed. Patients were divided into two groups: group I had ≤6 nodes and group II had >6 nodes retrieved. Survival was analyzed. Results One hundred and fifteen patients were included in the study. The 5 year overall survival was worse in group I versus II (P = 0.03). LVI and micrometastases were identified but neither predicted survival. Disease failure in group I was due to distant metastases rather than local recurrence. Conclusions Inadequate retrieval and assessment of lymph nodes is associated with worse outcome in stage II colon cancer patients. Recurrence patterns support the hypothesis that disease recurrence occurred due to inaccurate staging. In this small study, LVI or nodal micrometastases did not predict survival. Maximal attention should be paid to the total number of lymph nodes retrieved before embarking on potentially more resource intensive staging methods. J. Surg. Oncol. 2003;84:120–126. © 2003 Wiley‐Liss, Inc.