Colorectal cancer-number of lymphnodes (LN) examinate

We analyzed retrospectively surgical specimens from 345 colorectal cancer. The aim was to estimate the value of sampling lymph nodes (LN) located far sidelong colorectal cancer specimens. The fat from the mesocolon and perirectal space was divided into 2 fractions: close to (less than 5 cm) and distant (more than 5 cm) from the tumor. Tumors was located in the cecum (n=61),ascending colon (n=29),transverse colon (n=31),descending colon(n=27),sigmoid colon(n=108),rectum(n=89). The median number of LN sampled was 17 in the both fractions (range 4-26),12(range=0-21),in the close fraction and 3(range0-28),in the distant fraction. There were 169 pNo, 104 pN1, and 72 pN2 cases. The pN staging was accurate, except 10 based on the close fraction alone: of these,6 were upstaged from pNo to pN1 and 4 from pN1 to pN2, were the distant fraction was considered. In the colon, we found that LN location is more important than LN number because metastasic LN were present mostly in the peritumoral area. The suggests that LN should be initially recovered from the pericolic fat, close to the tumor. If there are less than 4 positive LN and less than 12 LN examined in total, additional LN should be retrieved from the distal fraction for potential upstaging. In the rectum, systematic sampling of close and distant LN is very important because rare cases, metastases are detected only in the distant LN, particularly at the patients who have undergone neoadjuvant radiotherapy. *Correspondence to: Kiss Lorant, Department of Patology, 1st Surgical Clinic, Emergency Academic Hospital Sibiu, University Lucian Blaga of Sibiu, Romania, E-mail: drkisslorant@yahoo.com Received: December 14, 2018; Accepted: January 03, 2019; Published: January 10, 2019 Introduction The presence of LN metastases in colorectal cancer is currently the most important factor in determining the indication for adjuvant therapy and is on the most important factor in estimation survival [16]. The total number of LN examined from colorectal cancer surgical specimens is associated with improved survival possibly because of increased accuracy in staging [2,6,7]. Cohen showed that the number of positive LN was related inversely to prognosis (pN1,66% 5 years survival), with the optimal dichotomization between 1 to 3, and 4 or more LN (pN2,37% 5 years) [1,8]. Recovering a larger number of LN reduces the possibility of missing a metastatic LN. The total number of LN required for adequate staging has long been a matter of controversy. The results from different series suggest that a minimum of 6 to 17 LN should be investigated for reliable node-negative staging [2-5,9] and the American Joint Committee on Cancer (AJCC) and IUAC (International Union Against Cancer) recommend a minimal assessment of 12 LN for accurate staging [10,11]. The extent of intestinal resection for colorectal cancer is related to the vascularization of the colon and rectum. This leading surgeon to resect broader regions than considered strictly necessary from an oncologic point of view. The contribution made by LN located in adjacent tissues relatively distant from the colorectal cancer was not investigated and their relative roles have not been taken into account in nodal staging. Systematic sampling of LN located in adjacent fat tissue relatively far from the colorectal cancer is both expensive and time-consuming and few studies have addressed it is a potential impact on pN status [9]. To determinate the value of systematically sampling distant LN in colorectal cancer surgical specimens in which the mesocolic and perirectal fat was divided into 2 fractions one close to the tumor (less than 5 cm) and the other distant from the tumor (more than 5 cm from both sides of the tumor). Materials and methods In this retrospectively study, we reviewed reports from the Pathology Department of Sibiu, from the 1st Surgical Clinic for all primary colorectal cancer surgical specimens collected between 20032014. A total 498 cases were reviewed, and 153 cases were excluded from the study because 10 cases of secondary excision for local tumor recurrence, 24 cases of multiple tumors and 119 cases in which proximal and distal fraction of the mesocolic and perirectal fat was not adequately individualized from colorectal cancer during microscopy. In total 345 cases were eligible for this study. Among the patients who have rectal cancer (n=89), 28% (n=25) had been treated with neoadjuvant radiotherapy, the rest of the patients benefited from postoperative radiotherapy as it was recommended in our hospital during the period. The mesocolic fat was divided to harvest LN from the colon cancer surgical specimens into fractions A and B. Fraction A was close to the tumor (less than 5 cm from both sides of the tumor). Fraction B was distant from the tumor (more than 5 cm). In colorectal tumor the direct extension of tumor cells in the intestinal wall did not occur more than 5 cm far from the primary tumor [12-14]. To guarantee Ro resection independently from LN and/or anatomic or vascular consideration a 5 cm safety surgical border was Lorant K (2018) Colorectal cancer-number of lymphnodes (LN) examinate Volume 4(1): 2-4 Clin Med Invest, 2018 doi: 10.15761/CMI.1000175 considered to be adequate. To harvest the LN of rectal cancer the perirectal fat (fraction A) and the perisigmoidian fat (fraction B) were separated. The same approach was exactly used for LN dissection in fraction A and B. The 2 fractions were separated into 2 different bottles and LN sampling was made the next day. LN staging was defined according to the TNM classification as pNo (0 positive LN), pN1(13 positive LN), a d pN2 (4 or more positive) [10,11]. Cutoff values of 12 or 18 LN were chosen according to the minimum number of LN recommended by the IUACC and according to Goldstein [4,5] who recommend a higher number (more than 18) of LN.