The determinants of an adequate lymph node harvest in surgery for rectal cancer: length, invasion, age and chemoradiation: P095


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Abstract

Aim:Nodal invasion is one of the most importantprognostic factors in rectal cancer. A minimum of 12 lymph nodes (LN) should be retrieved for correct staging. The number of retrieved LN seems to relate to several factors (surgical technique, tumour location, age andneoadjuvant chemoradiation).Method:Retrospective analysis of 289 consecutive patients surgically treated at a University Hospital for rectal cancer (Jan02-Dec07).Results:The harvest of > 12LN was more frequent in females (66.4% vs 54.5%; P = 0.05) and the correctly staged patients were younger (64 vs 67 years; P = 0.01).A sufficient harvest was less frequent after neoadjuvant chemoradiation (50.6% vs 63%; P = 0.05) and the average number of resected LN was lower (12 vs 15; P = 0.03). Patients with > 12LN resected had longer operative specimens (26 vs 19.7 cm; P = 0.005), and bigger tumours (4.5 vs 3.8 cm; P = 0.01). There were no significant differences in tumour location or type of surgery. Lymphatic invasion (P = 0.004) and nodal staging (P = 0.029) were directly related with the number of retrieved LN. In multivariate analysis, a correct harvest was independently related to the patient's age (P = 0.005), lengthofresection (P = 0.02), nodal staging (P = 0.03) andpreoperative chemoradiation (P = 0.05).Conclusion:The harvest of an adequate number of lymph nodes correlates directly with nodal staging and the specimen length and correlates inversely with patient age andpreoperative chemoradiation.

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