Lymph nodes detection and the mesorectal excision quality evaluation

Overview

Introduction:

Detection and examination of proper number of lymph nodes in patients after rectal resection is important for next treatment and management of patients with rectal carcinoma. There are no clear guideliness for minimal count of lymph nodes, variant recommendations agree on the number of 12 (10−14) nodes. There are situations, when is not easy to reach this count, mainly in older age groups and in patients after neoadjuvant, especially radiation therapy. As a modality for improvement of lymph nodes harvesting seems to be establishing of defined protocols originally designed for mesorectal excision quality evaluation.

Methods:

The investigation group was formed by patients examined in 2 three-years intervals before and after implementation of the protocol. Elevation in count of harvested lymph nodes was rated generaly and in relation to age groups and gender.

Results:

The average count of lymph nodes increased from 10 to 15 nodes, in subset of patients whose received neoadjuvant therapy from 7 to almost 14 nodes. The recommended number of lymph nodes was obtained in all investigated age groups. By the increased number of lymph nodes, rises also possibility of positive nodes found, that can lead to upstaging of the disease, in subset of patients whose received neoadjuvant therapy it is more than 4%.

Conclusion:

Our conclusions show, that forming of multidisciplinary cooperative groups (chiefly surgeon-pathologist), implementation of defined protocol of surgery, specimen manipulation and investigation by detached specialists lead to benefit consequences for further management and treatment of the patients with colorectal cancer.

Keywords:

mesorectal excision – circumferential resection margin (CRM) – stage according to TNM classification and Dukes classification – lymph nodes identiffication and harvesting and examination