There are numerous factors which can affect the lymph node(LN) yield in colon cancer specimens.The aim of this paper was to identify both modifiable and nonmodifiable factors that have been demonstrated toaffect colon...There are numerous factors which can affect the lymph node(LN) yield in colon cancer specimens.The aim of this paper was to identify both modifiable and nonmodifiable factors that have been demonstrated toaffect colonic resection specimen LN yield and to summarise the pertinent literature on these topics.A literature review of Pub Med was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens.The terms used for the search were:LN,lymphadenectomy,LN yield,LN harvest,LN number,colon cancer and colorectal cancer.Both nonmodifiable and modifiable factors were identified.The review identified fifteen non-surgical factors:(13 nonmodifiable,2 modifiable) which may influence LN yield.LN yield is frequently reduced in older,obese patients and those with male sex and increased in patients with right sided,large,and poorly differentiated tumours.Patient ethnicity and lower socioeconomic class may negatively influence LN yield.Pre-operative tumour tattooing appears to increase LN yield.There are many factors that potentially influence the LN yield,although the strength of the association between the two varies greatly.Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.展开更多
The debate regarding the two possible roles of lymphadenectomy in surgical oncology,prognostic or therapeutic,is still ongoing.Furthermore,the use of lymphadenectomy as a proxy for the quality of the surgical procedur...The debate regarding the two possible roles of lymphadenectomy in surgical oncology,prognostic or therapeutic,is still ongoing.Furthermore,the use of lymphadenectomy as a proxy for the quality of the surgical procedure is another feature of discussion.Nevertheless,this reckoning depends on patient conditions,aggressiveness of the tumor,the surgeon,and the pathologist,and then it is not an absolute surrogate for the surgical quality.The international guidelines recom-mend a minimum of 12 lymph nodes harvested for pathological examination in colorectal cancer(CRC)surgery.There is a growing literature on reporting better survival when the lymph node yield is high,even when these nodes are negative for malignancy.On the other hand,there are studies reporting no survival benefit with high lymph node yield in stage I-II of CRC.Herein we review the roles of the lymphadenectomy in CRC,and discuss the results of studies on lymph node harvesting.展开更多
AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection...AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.展开更多
BACKGROUND Mismatch repair deficient/microsatellite instability-high(MMR-D/MSI-H)colorectal cancers(CRCs)possess a distinctive genomic profile that results in a spectrum of phenotypic attributes setting them apart fro...BACKGROUND Mismatch repair deficient/microsatellite instability-high(MMR-D/MSI-H)colorectal cancers(CRCs)possess a distinctive genomic profile that results in a spectrum of phenotypic attributes setting them apart from their mismatch repair proficient(MMR-P)or microsatellite stable(MSS)counterparts.CRCs have several prognostic factors,including stage,tumor differentiation,location,lymphovascular and perineural invasion,tumor budding,tumor infiltrating lymphocytes,lymph node yield(LNY),and lymph node ratio(LNR).AIM To determine the unique phenotypic characteristics of MMR-D/MSI-H CRCs and leverage the conventional wisdom of LNY and LNR with the distinctive characteristics of MMR-D/MSI-H CRCs.METHODS This retrospective analysis involved 223 stage I-III CRC patients who underwent surgical resection without neoadjuvant treatment.Clinical and histological features were obtained from patient records and by re-examining the hematoxylin and eosin-stained slides.MMR/MSI status was evaluated for all patients using either MMR immunohistochemistry or MSI testing.RESULTS Of the 223 patients in our study,87(39.01%)were MMR-D/MSI-H CRCs while 136(60.99%)were MMR-P/MSS CRCs.The MMR-D/MSI-H CRCs exhibited significant statistical differences compared to the MMR-P/MSS CRCs in several factors,including location,stage,tumor budding,lymphovascular and perineural invasion,lymphocytic response,LNY,LNR,and size of uninvolved lymph nodes.LNY and LNR were significantly higher in MMR-D/MSI-H group compared with the MMR-P/MSS group(P=0.003 and P<0.001,respectively).Also,the interquartile range of the largest uninvolved lymph node was 1 cm(0.8 cm-1.2 cm)in MMR-D/MSI-H CRCs compared to 0.7 cm(0.6 cm-0.97 cm)in MMRP/MSS CRCs.The overall survival for the MMR-P/MSS CRC group was 71%at five years,and the MMR-D/MSIH CRC group was 92%at five years(P<0.001).CONCLUSION MMR-D/MSI-H CRCs possess a unique genomic profile that leads to distinct phenotypic characteristics,including an enhanced immune response.This distinctive profile underscores the substantial prognostic and predictive value of MMR-D/MSI-H status in CRC.展开更多
The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced le...The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition threedimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.展开更多
文摘There are numerous factors which can affect the lymph node(LN) yield in colon cancer specimens.The aim of this paper was to identify both modifiable and nonmodifiable factors that have been demonstrated toaffect colonic resection specimen LN yield and to summarise the pertinent literature on these topics.A literature review of Pub Med was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens.The terms used for the search were:LN,lymphadenectomy,LN yield,LN harvest,LN number,colon cancer and colorectal cancer.Both nonmodifiable and modifiable factors were identified.The review identified fifteen non-surgical factors:(13 nonmodifiable,2 modifiable) which may influence LN yield.LN yield is frequently reduced in older,obese patients and those with male sex and increased in patients with right sided,large,and poorly differentiated tumours.Patient ethnicity and lower socioeconomic class may negatively influence LN yield.Pre-operative tumour tattooing appears to increase LN yield.There are many factors that potentially influence the LN yield,although the strength of the association between the two varies greatly.Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.
文摘The debate regarding the two possible roles of lymphadenectomy in surgical oncology,prognostic or therapeutic,is still ongoing.Furthermore,the use of lymphadenectomy as a proxy for the quality of the surgical procedure is another feature of discussion.Nevertheless,this reckoning depends on patient conditions,aggressiveness of the tumor,the surgeon,and the pathologist,and then it is not an absolute surrogate for the surgical quality.The international guidelines recom-mend a minimum of 12 lymph nodes harvested for pathological examination in colorectal cancer(CRC)surgery.There is a growing literature on reporting better survival when the lymph node yield is high,even when these nodes are negative for malignancy.On the other hand,there are studies reporting no survival benefit with high lymph node yield in stage I-II of CRC.Herein we review the roles of the lymphadenectomy in CRC,and discuss the results of studies on lymph node harvesting.
文摘AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.
文摘BACKGROUND Mismatch repair deficient/microsatellite instability-high(MMR-D/MSI-H)colorectal cancers(CRCs)possess a distinctive genomic profile that results in a spectrum of phenotypic attributes setting them apart from their mismatch repair proficient(MMR-P)or microsatellite stable(MSS)counterparts.CRCs have several prognostic factors,including stage,tumor differentiation,location,lymphovascular and perineural invasion,tumor budding,tumor infiltrating lymphocytes,lymph node yield(LNY),and lymph node ratio(LNR).AIM To determine the unique phenotypic characteristics of MMR-D/MSI-H CRCs and leverage the conventional wisdom of LNY and LNR with the distinctive characteristics of MMR-D/MSI-H CRCs.METHODS This retrospective analysis involved 223 stage I-III CRC patients who underwent surgical resection without neoadjuvant treatment.Clinical and histological features were obtained from patient records and by re-examining the hematoxylin and eosin-stained slides.MMR/MSI status was evaluated for all patients using either MMR immunohistochemistry or MSI testing.RESULTS Of the 223 patients in our study,87(39.01%)were MMR-D/MSI-H CRCs while 136(60.99%)were MMR-P/MSS CRCs.The MMR-D/MSI-H CRCs exhibited significant statistical differences compared to the MMR-P/MSS CRCs in several factors,including location,stage,tumor budding,lymphovascular and perineural invasion,lymphocytic response,LNY,LNR,and size of uninvolved lymph nodes.LNY and LNR were significantly higher in MMR-D/MSI-H group compared with the MMR-P/MSS group(P=0.003 and P<0.001,respectively).Also,the interquartile range of the largest uninvolved lymph node was 1 cm(0.8 cm-1.2 cm)in MMR-D/MSI-H CRCs compared to 0.7 cm(0.6 cm-0.97 cm)in MMRP/MSS CRCs.The overall survival for the MMR-P/MSS CRC group was 71%at five years,and the MMR-D/MSIH CRC group was 92%at five years(P<0.001).CONCLUSION MMR-D/MSI-H CRCs possess a unique genomic profile that leads to distinct phenotypic characteristics,including an enhanced immune response.This distinctive profile underscores the substantial prognostic and predictive value of MMR-D/MSI-H status in CRC.
文摘The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition threedimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.
