Lymph node threshold in colorectal cancer: surgeons' perspectives and practices

Current guidelines emphasise examining at least 12 lymph nodes (LN) in colorectal cancer resections. This study surveyed surgeon perspectives on suboptimal LN yield (<12) to assess interpretive variability and beliefs regarding its clinical impact.

A voluntary 19-question electronic survey was distributed to colorectal and general surgeons, exploring clinical, pathological and molecular considerations in cases with low LN yield.

Among 168 respondents (58% colorectal surgeons; 32% general surgeons), most practised in academic or mixed settings, and 73% had over 10 years of experience. While 71% reported suboptimal LN yields as infrequent, 29% encountered them more regularly. A majority (92%) contacted pathology when LN yield was low; however, opinions diverged on next steps-particularly when maximum N-stage was already achieved or when considering total fat submission. Nearly half (49%) believed that low LN yield rarely alters treatment decisions, yet many acknowledged its association with poorer outcomes. Regarding potential contributing factors, 56% cited neoadjuvant therapy, 47% noted specimen length or sidedness, but most did not consider mismatch repair status, age or body mass index to significantly impact LN yield.

Despite the '12-node rule', surgeon perspectives vary regarding the significance, aetiology and clinical consequences of suboptimal LN yield. The overarching message for pathology is that thoughtful communication among surgeons and pathologists is critical to understand the idiosyncrasies around individualised care and nuances around factors that may influence LN yield, with the ultimate hope to best manage resources and optimise patient care.