Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma
As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and E...
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| Format: | Article |
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Wiley
2018-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/1985031 |
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| author | Ameer Hamza Ramen Sakhi Sidrah Khawar Ahmed Alrajjal Jacob Edens Muhammad Siddique Khurram Uqba Khan Susanna Szpunar Paul Mazzara |
| author_facet | Ameer Hamza Ramen Sakhi Sidrah Khawar Ahmed Alrajjal Jacob Edens Muhammad Siddique Khurram Uqba Khan Susanna Szpunar Paul Mazzara |
| author_sort | Ameer Hamza |
| collection | DOAJ |
| description | As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated. |
| format | Article |
| id | doaj-art-2a04488544d6420fb592b7961cfb2837 |
| institution | OA Journals |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-2a04488544d6420fb592b7961cfb28372025-08-20T02:03:59ZengWileyGastroenterology Research and Practice1687-61211687-630X2018-01-01201810.1155/2018/19850311985031Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal CarcinomaAmeer Hamza0Ramen Sakhi1Sidrah Khawar2Ahmed Alrajjal3Jacob Edens4Muhammad Siddique Khurram5Uqba Khan6Susanna Szpunar7Paul Mazzara8St. John Hospital and Medical Center, Detroit, MI, USASt. John Hospital and Medical Center, Detroit, MI, USASt. John Hospital and Medical Center, Detroit, MI, USASt. John Hospital and Medical Center, Detroit, MI, USASt. John Hospital and Medical Center, Detroit, MI, USAVanderbilt University Medical Center, Nashville, TN, USASt. John Hospital and Medical Center, Detroit, MI, USASt. John Hospital and Medical Center, Detroit, MI, USASt. John Hospital and Medical Center, Detroit, MI, USAAs with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.http://dx.doi.org/10.1155/2018/1985031 |
| spellingShingle | Ameer Hamza Ramen Sakhi Sidrah Khawar Ahmed Alrajjal Jacob Edens Muhammad Siddique Khurram Uqba Khan Susanna Szpunar Paul Mazzara Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma Gastroenterology Research and Practice |
| title | Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma |
| title_full | Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma |
| title_fullStr | Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma |
| title_full_unstemmed | Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma |
| title_short | Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma |
| title_sort | role of second look lymph node search in harvesting optimal number of lymph nodes for staging of colorectal carcinoma |
| url | http://dx.doi.org/10.1155/2018/1985031 |
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