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Liu Q, Huang M, Yang J, Jiang M, Zhao Z, Zhao H, He T, Bai Y, Zhang R, Zhang M. Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis. BMJ Open 2023; 13:e072244. [PMID: 38135324 DOI: 10.1136/bmjopen-2023-072244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer. DESIGN Systematic review and meta-analysis of primary studies. DATA SOURCES PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included. DATA EXTRACTION AND SYNTHESIS OR with 95% conference intervals was extracted and pooled. RESULTS A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph-vascular invasion were not significantly associated with the lymph node yield. CONCLUSIONS The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.
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Affiliation(s)
- Qianqian Liu
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Min Huang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jing Yang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Mengyuan Jiang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ziru Zhao
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Haitong Zhao
- Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Tingting He
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuping Bai
- The Department of Pathology, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Rui Zhang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Min Zhang
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Ballanamada Appaiah NN, Rafaih Iqbal M, Kafayat Lesi O, Medappa Maruvanda S, Cai W, Rajakumar A, Khan L. Clinicopathological Factors Affecting Lymph Node Yield and Positivity in Left-Sided Colon and Rectal Cancers. Cureus 2021; 13:e19115. [PMID: 34858756 PMCID: PMC8614181 DOI: 10.7759/cureus.19115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Colorectal cancer (CRC) is a significant cause of cancer‐related deaths worldwide and is the third most common cause of cancer deaths in the UK. The status of lymph node metastasis is a key factor for predicting the prognosis of a patient's CRC. Aims This study aimed to analyze the demographics of left-sided colonic and rectal cancers at a single institution. We looked closely at the correlation between patient age and various histological factors. We tried to find any significant difference in lymph node yield (LNY) between laparoscopic surgery (LS) and open surgery (OS). We aimed to identify any statistical correlation between LNY and lymph node positivity (LNP) with other patient, surgical and histopathological features. Methodology This is a retrospective, non-interventional review of consecutive patients who underwent left-sided colonic and rectal cancer resections over a three-year period between 01 April 2018 and 31 March 2021. Descriptive and inferential statistical analyses were used. Chi-squared / Fisher exact test was used on a categorical scale between two or more groups and non-parametric setting for qualitative data analysis. Results A total of 102 patients were included in the study. No statistical correlation was found between the age of the patient with the LNY, LNP, location of the tumor, type, and urgency of the operation. LNY ranged between one and 43 nodes (median (interquartile range (IQR)) 17, 8). There was no statistically significant difference in LNY between laparoscopic surgery (LS) and open surgery (OS) (p=0.1449). Significant statistical correlation was identified between LNP and completeness of resection (CoR) (p=0.039), vascular invasion (VI) (p<0.001), perineural invasion (PI) (p<0.001), and circumferential resectional margin involvement (CRMI) (p=0.039). Discussion LNY and LNP are important prognostic indices in colorectal cancer. Patient age, tumor location, the urgency of surgery, and consultant experience did not significantly impact the LNY. Our study showed a positive correlation between LNP and CRMI, VI and PI comparable to literature. Contrary to other studies, we found no statistical significance between LS vs. OS and LNY. Whether 12 nodes per patient is an appropriate level remains controversial.
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Affiliation(s)
| | - Muhammad Rafaih Iqbal
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Omotara Kafayat Lesi
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | | | - Wenyi Cai
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Andrien Rajakumar
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Laeeq Khan
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
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