The following is a summary of “Lymph node retrieval colon cancer: Are we making the grade?,” published in the OCTOBER 2023 issue of Surgery by Webber, et al.
In the context of colon cancer, achieving a sufficient lymph node (LN) excision during surgery is critical for accurate pathologic staging and the determination of whether adjuvant treatment is required.
The study involved querying the National Cancer Database (NCDB) spanning 2004 to 2017, specifically looking at patients who underwent curative colon cancer resections. Tumors were categorized based on their location within the colon, distinguishing between those in the left, right, and transverse colon. The study evaluated the adequacy of lymphadenectomy, with categories defined as inadequate (<12 LNs) and adequate (12–20 LNs). A further sub-analysis was conducted for cases with less than 12 LNs, those with 12–20 LNs, and those with more than 20 LNs. The primary outcome examined was the identification of predictors associated with inadequate lymph node retrieval.
Among the 101,551 patients studied, 11.2% (11,439) experienced inadequate lymphadenectomy. Notably, the rate of inadequate lymphadenectomy exhibited a steady decline over the years. Upon conducting a multivariable analysis, inadequate LN retrieval was found to be associated with transverse colon cancers (odds ratio [OR] 1.49, 95% CI [1.30–1.71]) and left colon cancers (OR 2.66, CI [2.42–2.93]). Conversely, patients with an income exceeding $63,333 had a reduced likelihood of inadequate LN retrieval (OR 0.68, CI [0.56–0.82]).
The study results indicated a positive trend, as the data from the NCDB shows a consistent decrease in the rate of inadequate lymphadenectomy from 2004 to 2017. However, there were still socioeconomic factors associated with an increased risk of inadequate lymphadenectomy that warrants further attention and intervention.