Numbers of Lymph Nodes in Large Intestinal Resections for Colorectal Carcinoma

Overview

Introduction:
Precise evaluation of lymph nodes in the surgical specimen is crucial for the staging and subsequent decision about the adjuvant therapy in colorectal cancer. Prognosis of the patients can be assessed only in cases when at least 12 lymph nodes in the surgical specimen are examined.

Aim of the work:
To evaluate the radicalism of resections for colorectal carcinoma after introducing laparoscopic approach.

Methods:
We compared all resections for primary colorectal cancer and rectal cancer (C18-C20) performed in the Department of Surgery in University Hospital Hradec Králové in the years 2005 and 2008 and we evaluated numbers of examined lymph nodes in the surgical specimens. The patients with recurrent tumours and the patients with complete pathological response (negative histology) after neoadjuvant therapy were excluded from the study.

Results:
117 patients were included in the study in 2005, 2 of them were operated laparoscopically. 155 patients (more by 32.5%) were included in the study in 2008, 53 of them (34.2%) were operated laparoscopically. In tumours of the right part of the colon (C180-C184) treated by right hemicolectomy: on an average 7.9 (± 5.3) lymph nodes were examined in the specimens in 2005, and 15.3 (± 7.0) lymph nodes in 2008. In tumours of the left part of the colon (C185-C186) treated by left hemicolectomy: 6.5 (± 5.1) lymph nodes were examined in 2005, and 19.6 (± 15.6) in 2008. In tumours of the sigmoid colon (C187) 9.1 (± 6.9) lymph nodes were examined in 2005, and 15.4 (± 7.9) in 2008. In tumours of the rectosigmoid junction (C19) 8.0 (± 6.9) lymph nodes were examined in 2005, and 17.8 (± 11.2) in 2008. In rectal cancer (C20) 5.2 (± 4.5) lymph nodes were examined in 2005, and 13.6 (± 12.5) in 2008. There is a significant difference in a number of examined lymph nodes in patients without neodadjuvant treatment compared to those with neoadjuvant chemoradiotherapy and neoadjuvant radiotherapy. In 2005, in an average 3.7 (± 3.3) lymph nodes were removed in rectal resections after neoadjuvant chemoradiotherapy, in 2008 in an average 7.6 (± 6.1) lymph nodes were removed. In 2005, in an average 5.1 (± 3.7) lymph nodes in rectal resections after neoadjuvant radiotherapy were removed, in 2008 6.3 (± 4.3) lymph nodes were removed. In 2005, in an average 7.0 (± 5.5) lymph nodes in rectal resections without neoadjuvant therapy were removed, in 2008 20.9 (± 14.1) lymph nodes were removed. Laparoscopic resections were comparable with open resections regarding the number of examined lymph nodes in our group of patients.

Conclusion:
Introducing the laparoscopic approach to resections of colorectal carcinomas did not decrease radicalism of the operation as to the number of removed lymph nodes.

Key words:
colorectal cancer – lymph nodes – N staging