Lymph Node Yield and Colorectal Cancer Survival: A Bowel Cancer Outcomes Registry Cohort Study

Area of Science:

• Oncology
• Surgical Pathology

Background:

• Current colorectal cancer (CRC) surgery standards recommend a minimum of 12 lymph node (LN) dissections.
• Emerging evidence suggests that increased LN yield may enhance disease-free survival (DFS), but an optimal number remains undefined.

Purpose of the Study:

• To investigate the correlation between the number of lymph nodes (LNs) resected and survival outcomes in patients undergoing surgery for nonmetastatic colorectal cancer (CRC).

Main Methods:

• Analysis of data from the Bowel Cancer Outcomes Registry (BCOR) in Australia and New Zealand.
• Inclusion criteria: patients aged ≥18 years with histologically confirmed, nonmetastatic CRC and documented follow-up.
• Outcomes assessed via logistic regression, focusing on CRC-specific mortality, CRC recurrence, and all-cause mortality.

Main Results:

• A total of 10,616 eligible patients were analyzed from 91,271 patient episodes.
• Median LN yield was 18; patients were categorized into quartiles (≤12, 13-17, 18-23, >23).
• Significantly higher CRC-specific mortality was observed in the lowest quartile (≤12 LNs) compared to other groups (p=0.023). CRC recurrence and CRC-specific mortality were higher in the ≤12 LNs group (16.0% vs. 14.0% and 4.5% vs. 3.3%, respectively).

Conclusions:

• This study reinforces the established guideline of resecting more than 12 lymph nodes (LNs) for adequate staging and oncological clearance in colorectal cancer (CRC) surgery.
• Lymph node yields of 12 or fewer LNs are associated with increased rates of CRC recurrence and mortality.