title: What is the optimal number of lymph nodes to be dissected in colorectal cancer surgery?
abstract: BACKGROUND
  Regional lymph node (LN) involvement in colorectal cancer (CRC) identifies the stage and the subset of patients who would benefit from adjuvant chemotherapy. We performed a retrospective analysis to determine if the number of recovered LNs was associated with long-term outcome in patients operated on for stage II and III CRC.
  
  
  METHODS
  Hospital records of 179 patients with CRC followed in our unit from 1997 to April 2003 were reviewed.
  
  
  RESULTS
  On average 11.68 +/- 7.3 LNs were sampled per surgical specimen. Sampling of at least nine LNs appeared to be the minimum number required for accurately predicting LN involvement (P = 0.002). Three-year rates of disease-free survival (DFS), local recurrence-free survival (LRFS) and overall survival (OS) were lower in patients with fewer than nine LNs sampled (P = 0.032, P = 0.006 and P = 0.04, respectively). However, this had no impact on the three-year distant metastasis-free survival rate (DMFS) (P = 0.472). In stage II disease, patients with nine or more LNs dissected had significantly higher three year DFS and LRFS rates than the subgroup with fewer than nine LNs dissected (P = 0.024 and P = 0.015, respectively), but this did not have any effect on DMFS or OS (P = 0.406 and P = 0.353, respectively).
  
  
  CONCLUSIONS
  Current protocols provide adjuvant treatment in stage III patients; the problem is to correctly determine stage by recovering as many LNs as possible.
authors.affiliation: Oncology Division, Department of Internal Medicine, Marmara University Hospital, Istanbul, Turkey. mgumus@superonline.com
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gumus
authors.forename: Perran Fulden
authors.initials: PF
authors.lastname: Yumuk
authors.forename: Gul
authors.initials: G
authors.lastname: Atalay
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aliustaoglu
authors.forename: Beyza
authors.initials: B
authors.lastname: Macunluoglu
authors.forename: Faysal
authors.initials: F
authors.lastname: Dane
authors.forename: Hale
authors.initials: H
authors.lastname: Caglar
authors.forename: Meric
authors.initials: M
authors.lastname: Sengoz
authors.forename: Serdar
authors.initials: S
authors.lastname: Turhal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome