From Medscape General Surgery

Viewpoint: How Many Lymph Nodes Should Be Examined for Colorectal
Cancer Staging?
Posted 10/18/2005

Albert B. Lowenfels, MD

Assessing the Quality of Colorectal Cancer Staging
Wong JH, Johnson DS, Hemmings D, Hsu A, Imai T, Tominaga GT
Arch Surg. 2005;140:881-887

Summary
The aim of this study was to assess whether examining 14 or more
lymph nodes provides sufficient information to accurately stage
patients with colorectal cancer. The study group consisted of 2149
patients with colorectal cancer from community medical centers in
Hawaii. Disease-specific patient survival data were used to produce
Kaplan-Meier survival curves. Although there were center-specific
differences in the number of lymph nodes examined, the mean number of
nodes studied at each center equaled or exceeded 14. In node-negative
patients in whom less than 14 nodes were examined, survival was
significantly poorer than survival in patients in whom more nodes
were examined. This suggests that 14 or more nodes are necessary for
accurate staging.

Viewpoint
Under the TMN system, lymph node status is an essential part of
classification of colorectal cancer patients. Obviously, the more
nodes that are studied, the higher the accuracy of assessing the
spread of cancer to the lymph nodes. This study presents solid
evidence that a minimum of 14 nodes should be examined to give an
accurate assessment of lymph node status.

Abstract




Albert B. Lowenfels, MD, Professor of Surgery, Department of Surgery,
New York Medical College, Valhalla, New York; Staff Physician,
Westchester Medical Center, Valhalla, New York


Disclosure: Albert B. Lowenfels, MD, has disclosed no relevant
financial relationships.


Medscape General Surgery. 2005;7(2) ©2005 Medscape