Osman CİVİL, Ali ÇİFTÇİ, Nuri OKKABAZ, Tevfik Tolga ŞAHİN, Abdullah GÜNEŞ, Cağrı TİRYAKİ, M.Burc YAZICIOĞLU, Dincer AYDIN

Comprehensive analysis of impacts of lymph node yield on patient survival and recurrence in patients with stage II rectal cancer: A single institution study

Aim: Pathologic evaluation of rectal cancer is very important. Lymph node yields may be related to surgical technique or inadequate harvesting in the pathology department. The importance of lymph node yields >12 have been emphasized by many researchers to be adequate for staging. In stage II rectal cancer, the impacts of lymph node yield on locoregional recurrence and patient survival have not been studied. The aim of the present study is to evaluate the impact of lymph node yield on outcome and prognosis of the patients with stage II rectal cancer.Material and Methods: Patients with stage II rectal cancer who were operated in our institution between 2008 and 2013 were retrospectively analyzed to determine the impact of lymph node yield on survival, locoregional and distant metastasis.Results: Overall, local and distant recurrence rates were 13.9%, 4.65% and 9.30%; respectively. We did not find any significant difference in terms of locoregional and distant metastasis rates among Group I (lymph node12) (p>0.05). The 5-year survival of the patients in Group 1 versus Group 2 were 86.7% versus 82%; respectively (p>0.05).Conclusions: Results of the present study emphasize that lymph node yields may not have an impact on patient survival or recurrence. However, the patient groups were heterogeneous and the volume was low, therefore, more studies with higher volumes are needed.

PDF

___

1. Nikberg M, Chabok A, Letocha H, et al. Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry. Acta Oncol 2016;55:1418-24.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7-30.
3. Mayir B, Ensari CÖ, Durhan A, et al. Colonoscopy findings in patients who have positive fecal occult blood test for colorectal cancer screening. Turk J Colorectal Dis 2018;28:27-30.
4. Gultekin M. Türkiye Kanser İstatistikleri 2016. Kanser Daire Başkanlığı [Internet]. [cited 2018 Jul 4]. Available from: http://www.onkoloji.gov.tr/attachments/article/8653/Ana%20Rapor%202016%20(v01.2).pdf
5. Benson AB, Schrag D, Somerfield MR, et al. American society of clinical oncology recommendations on adjuvant chemotherapy for stage ii colon cancer. J Clin Oncol 2004;22:3408-19.
6. de Campos-Lobato LF, Stocchi L, de Sousa JB, et al. Less than 12 nodes in the surgical specimen after total mesorectal excision following neoadjuvant chemoradiation: it means more than you think! Ann Surg Oncol 2013;20:3398-406.
7. Washington MK, Berlin J, Branton P, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009;133:1539-51.
8. Anthony T, Simmang C, Hyman N, et al. Practice parameters for the surveillance and follow-up of patients with colon and rectal cancer. Dis Colon Rectum 2004;47:807-17.
9. Stocchi L, Fazio VW, Lavery I, et al. Individual surgeon, pathologist, and other factors affecting lymph node harvest in stage II colon carcinoma. is a minimum of 12 examined lymph nodes sufficient? Ann Surg Oncol 2011;18:405-12.
10. Wang J, Kulaylat M, Rockette H, et al. Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg 2009;249:559-63.
11. Phang PT. Total mesorectal excision: technical aspects. Can J Surg 2004;47:130-7.
12. Ahn YJ, Kwon HY, Park YA, et al. Contributing factors on lymph node yield after surgery for mid-low rectal cancer. Yonsei Med J 2013;54:389-95.
13. Goldstein NS, Sanford W, Coffey M, et al. 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 1996;106:209-16.
14. Rullier A, Laurent C, Capdepont M, et al. Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol 2008;32:45-50.
15. Brown G, Radcliffe AG, Newcombe RG, et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 2003;90:355-64.
16. Willett CG, Badizadegan K, Ancukiewicz M, et al. Prognostic factors in stage T3N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum 1999;42:167-73.
17. Tang R, Wang JY, Chen JS, et al. Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 1995;180:705-12.
18. Talbot IC, Ritchie S, Leighton MH, et al. The clinical significance of invasion of veins by rectal cancer. Br J Surg 1980;67:439-42.
19. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994;344:707-11.
20. Shepherd NA, Baxter KJ, Love SB. Influence of local peritoneal involvement on pelvic recurrence and prognosis in rectal cancer. J Clin Pathol 1995;48:849-55.
21. Peng J, Sheng W, Huang D, et al. Perineural invasion in pT3N0 rectal cancer: the incidence and its prognostic effect. Cancer 2011;117:1415-21.
22. Quasar Collaborative Group, Gray R, Barnwell J, McConkey C, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 2007;370:2020-9.
23. Guillem JG, Chessin DB, Cohen AM, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 2005;241:829-36.
24. Lin HH, Chang YY, Lin JK, et al. The role of adjuvant chemotherapy in stage II colorectal cancer patients. Int J Colorectal Dis 2014;29:1237-43.
25. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 1982;69:613-6.
26. Kim CW, Kang BM, Kim IY, et al. Korean Society of Coloproctology (KSCP) trial of cONsolidation Chemotherapy for Locally advanced mid or low rectal cancer after neoadjUvant concurrent chemoraDiothErapy: a multicenter, randomized controlled trial (KONCLUDE). BMC Cancer 2018;18:538.
27. Tournigand C, de Gramont A. Chemotherapy: Is adjuvant chemotherapy an option for stage II colon cancer? Nat Rev Clin Oncol 2011;8:574-6.