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Lymph node retrieval colon cancer: Are we making the grade?
Alexis A Webber1, Piyush Gupta1, Peter W Marcello1
1The Department is the Department of Colon and Rectal Surgery at Lahey Hospital and Medical Center, United States.
American Journal of Surgery
|June 22, 2023
Summary
Adequate lymph node retrieval in colon cancer surgery is improving, but socioeconomic factors still influence the rate of inadequate lymphadenectomy, requiring further attention.
Area of Science:
- Oncology
- Surgical Pathology
- Public Health
Background:
- Adequate lymph node (LN) excision is critical for accurate colon cancer staging and guiding adjuvant therapy decisions.
- Pathologic staging relies on the number of lymph nodes examined to determine the extent of disease.
- Insufficient lymphadenectomy can lead to understaging and suboptimal treatment planning.
Purpose of the Study:
- To identify predictors of inadequate lymph node retrieval during curative colon cancer resections.
- To analyze trends in lymphadenectomy adequacy over time.
- To investigate the impact of tumor location and patient socioeconomic status on lymph node retrieval.
Main Methods:
- Analysis of the National Cancer Database (NCDB) from 2004-2017.
- Inclusion of patients undergoing curative colon cancer resections.
- Categorization of tumors by location (left, right, transverse colon) and lymphadenectomy adequacy (<12 LNs vs. 12-20 LNs).
Main Results:
- 11.2% of 101,551 patients had inadequate lymphadenectomy, with a decreasing trend observed.
- Inadequate lymph node retrieval was significantly associated with transverse (OR 1.49) and left colon cancers (OR 2.66).
- Higher income (>$63,333) was associated with a decreased likelihood of inadequate lymph node retrieval (OR 0.68).
Conclusions:
- While the rate of inadequate lymphadenectomy is decreasing, it has not been eliminated.
- Socioeconomic factors remain significant predictors of inadequate lymph node retrieval.
- Targeted interventions are needed to address disparities in lymphadenectomy adequacy.
