Factors Influencing the Number of Lymph Nodes Harvested for Stage I-III Colorectal Cancer in Thai Patients
Introduction: Lymph node (LN) status is the most important predictor of survival in non-metastatic colorectal cancer (CRC). Recent guidelines recommend that a minimum of 12 nodes be examined for accurate staging. Three major classes of factors may influence the number of IN examined, including surgeon, pathologist and tumor/host factors.
Objectives: To identify factors influencing the number of LN harvested for stage I-III CRC in Thai patients and to review the adequacy of LN harvested by one surgeon.
Patients and Methods: A retrospective study of stage I-II CRC patients who underwent curative-intent resection by one surgeon was performed. Patients who underwent subtotal or total colectomy and patients who had preoperative chemoradiation were excluded. Variability in the quality of surgical technique was reduced by including patients who had operations performed by one surgeon only.
Results: From January 2001 to February 2008, 278 patients including 135 (49%) males and 143 (51%) females were eligible for analysis. The mean age was 62.3 years (SD, 11.8 years). There were 157 colon cancers (56.5%) and 121 rectal cancers (43.5%). The mean number of LN harvested was 17.3 nodes (18.7 nodes for colon cancer and 15.4 nodes for rectal cancer) with a median of 15 nodes (colon cancer, 16 nodes; rectal cancer, 14 nodes). Overall, 41 patients (15%) had inadequate LN harvest (<12 nodes; colon cancer, 8%; rectal cancer, 24%). Multivariable analysis revealed that factors associated with inadequate LN harvest included older age (>70years), left-sided colon or rectal cancer and early T-stage.
Conclusions: Excluding surgeon and pathologist factors, the number of harvested LNs in Thai patients was affected by patient and tumor factors, including age, location of tumor and T-stage. The high proportion of adequate LN harvest in the present study was probably due to a high volume caseload and the uniformly good quality of surgery as performed by one surgeon.
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