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How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum?

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Abstract

The lymph-node yields in specimens resected for colorectal adenocarcinoma show considerable variations, raising the question whether the minimum lymph-node number recommended by the UICC (International Union Against Cancer) for pN0 classification represents an appropriate quality standard for specimen work-up. The number of pericolic lymph nodes recovered from 568 archival surgical colorectal carcinoma specimens located in the sigmoid or upper rectum showed a highly statistically significant correlation with both the pT category and the presence of metastases (P<0.0005). The median lymph-node yield in standardized (i.e., resembling in size surgically removed cancer specimens) tumor-free specimens obtained during autopsies was 13 lymph nodes, compared with 20.5 when diverticula were present and more than 30 in specimens with chronic inflammation or from patients with systemic infections. In 48 pT2 and pT3 carcinoma specimens prospectively dissected in the same way, median numbers of 18 (pT2) and 23 (pT3) lymph nodes were detected (range between 8 and 39 nodes). The lymph-node numbers recommended in previous studies and by the UICC often seem to be too low to declare a specimen free of metastases. Although the great variation in lymph-node counts requires the recovery of all lymph nodes for pN0 classification, recommendations considering the pT status and additional factors like diverticula and inflammatory changes can be useful as a quality standard for specimen work up.

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References

  1. Andreola S, Leo E, Belli F, et al (1996) Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm. Cancer 77:607–612

    Article  CAS  PubMed  Google Scholar 

  2. Arnold MW, Young DM, Hitchcock CL, et al (1998) Staging of colorectal cancer: biology vs. morphology. Dis Colon Rectum 41:1482–1487

    CAS  PubMed  Google Scholar 

  3. Caplin S, Cerottini JP, Bosman FT, et al (1998) For patients with Dukes B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer 83:666–672

    Article  CAS  PubMed  Google Scholar 

  4. Cawthorn SJ, Gibbs NM, Marks CG (1986) Clearance technique for the detection of lymph nodes in colorectal cancer. Br J Surg 73:58–60

    CAS  PubMed  Google Scholar 

  5. Cianchi F, Palomba A, Boddi V, et al (2002) Lymph node recovery from colorectal tumor specimens: recommendation for a minimum number of lymph nodes to be examined. World J Surg 26:384–389

    Article  PubMed  Google Scholar 

  6. Cserny G, Vinh-Hung V, Burzykowski T (2002) Is there a minimum number of lymph nodes that should be histologically assessed for a reliable nodal staging of T3N0M0 colorectal carcinomas? J Surg Oncol 81:63–69

    Google Scholar 

  7. Davidson BR, Sams VR, Styles J, et al (1990) Detection of occult nodal metastases in patients with colorectal carcinoma. Cancer 65:967–970

    CAS  PubMed  Google Scholar 

  8. Fielding LP (1999) Invited editorial. Dis Colon Rectum 42:154–158

    Google Scholar 

  9. Goldstein NS (2002) Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 36:179–189

    Article  Google Scholar 

  10. Goldstein NS, Sanford W, Coffey M, et al (1996) Lymph node recovery from colorectal resection specimens removed for adenocarcinoma: trends over time and a recommendation for a minimum number of lymph nodes to be recovered. Am J Clin Pathol 106:209–216

    CAS  PubMed  Google Scholar 

  11. Hermanek P (1991) Onkologische Chirurgie/Pathologisch-anatomische Sicht. Langenbecks Arch Chir Suppl Kongressbd, pp 277–281

  12. Hernanz F, Revuelta S, Redondo C, et al (1994) Colorectal adenocarcinoma: quality of the assessment of lymph node metastases. Dis Colon Rectum 37:373–377

    CAS  PubMed  Google Scholar 

  13. Herrera L, Villarreal JR (1992) Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique. Dis Colon Rectum 35:783–788

    CAS  PubMed  Google Scholar 

  14. Herrera-Ornelas L, Justiniano J, Castillo N, et al (1987) Metastases in small lymph nodes from colon cancer. Arch Surg 122:1253–1256

    CAS  PubMed  Google Scholar 

  15. Hida J, Mori N, Kubo R, et al (1994) Metastases from carcinoma of the colon and rectum detected in small lymph nodes by the clearing method. J Am Coll Surg 178:223–228

    CAS  PubMed  Google Scholar 

  16. Hyder JW, Talbott TM, Maycroft TC (1990) A critical review of chemical lymph node clearance and staging of colon and rectal cancer at Ferguson Hospital. Dis Colon Rectum 33:923–925

    CAS  PubMed  Google Scholar 

  17. Jamieson JK, Dobson JF (1909) Lymphatics of colon with special reference to the operative treatment of cancer of colon. Ann Surg 1:1077

    Google Scholar 

  18. Jass JR, Miller K, Northover JMA (1986) Fat clearance method versus manual dissection of lymph nodes in specimens of rectal cancer. Int J Colorectal Dis 1:155–156

    CAS  PubMed  Google Scholar 

  19. Jeffers MD, O'Dowd GM, Mulcahy H (1994) The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma. J Pathol 172:183–187

    CAS  PubMed  Google Scholar 

  20. Liefers GJ, Cleton-Jansen AM, van de Velde CJH, et al (1998) Micrometastases and survival in stage II colorectal cancer. N Engl J Med 339:223–228

    CAS  PubMed  Google Scholar 

  21. Mainprize KS, Hewavisinthe J, Savage A, et al (1998) How many lymph nodes to stage colorectal carcinoma? J Clin Pathol 51:165–166

    Google Scholar 

  22. Maurel J, Launoy G, Grosclaude P, et al (1998) Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based study. Cancer 82:1482–1486

    Article  CAS  PubMed  Google Scholar 

  23. Ratto C, Sofo L, Ippoliti M, et al (1999) Accurate lymph node detection in colorectal specimens resected for cancer is of prognostic significance. Dis Colon Rectum 42:143–154

    CAS  PubMed  Google Scholar 

  24. Scott KW, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167

    CAS  PubMed  Google Scholar 

  25. Scott KW, Grace RH, Gibbons P (1994) Five year follow-up study of the fat clearance technique in colorectal carcinoma. Dis Colon Rectum 37:126–128

    CAS  PubMed  Google Scholar 

  26. Slanetz CA, Herter FP (1972) The large intestine In: Haagensen CD (ed) The lymphatics in cancer. Saunders, Philadelphia, pp 489–513

    Google Scholar 

  27. Sobin LH, Greene FL (2001) TNM classification: clarification of number of regional lymph nodes. Cancer 92:452

    Article  CAS  PubMed  Google Scholar 

  28. Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumors. In: International Union Against Cancer (UICC) (6th edn). Wiley-Liss, New York

  29. Soderstrom N (1967) Post-capillary venules as basic structural units in the development of lymphogranular tissue. Scand J Haematol 4:411–429

    CAS  PubMed  Google Scholar 

  30. Swanson RS, Compton CC, Stewart Ak, et al (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71

    Article  PubMed  Google Scholar 

  31. Swartz MA, Skobe M (2001) Lymphatic function, lymphangiogenesis, and cancer metastasis. Microsc Res Tech 55:92–99

    Article  CAS  PubMed  Google Scholar 

  32. Tepper JE, O'Connell MJ, Niedzwiecki D, et al (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163

    CAS  PubMed  Google Scholar 

  33. Wong JH, Severino R, Honnebier MB, et al (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900

    CAS  PubMed  Google Scholar 

  34. Wong JH, Bowles BJ, Bueno R, et al (2002) Impact of the number of negative nodes on disease-free survival in colorectal cancer patients. Dis Col Rectum 45:1341–1348

    Google Scholar 

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Acknowledgements

The authors thank Drs. B. Grasser, T. Thalhammer and P. Bergmann from the Surgical Department of the University of Graz for the standard resection of several "pT0" sigmoidorectal specimens during autopsies and Prof. Dr. Firbas and Ms I. Klausnitzer from the Institute of Anatomy, University of Vienna, for valuable advice.

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  1. Department of Pathology, University of Graz, School of Medicine, Auenbruggerplatz 25, 8036 , Graz, Austria

    Sebastian Leibl, Oleksiyy Tsybrovskyy & Helmut Denk

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  1. Sebastian Leibl
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  2. Oleksiyy Tsybrovskyy
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  3. Helmut Denk
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Correspondence to Sebastian Leibl.

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Leibl, S., Tsybrovskyy, O. & Denk, H. How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum?. Virchows Arch 443, 133–138 (2003). https://doi.org/10.1007/s00428-003-0858-3

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  • DOI: https://doi.org/10.1007/s00428-003-0858-3

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