title: A systematic review on the significance of extracapsular lymph node involvement in gastrointestinal malignancies.
abstract: OBJECTIVE
  The impact of extracapsular lymph node involvement (LNI) has been studied for several malignancies, including gastrointestinal malignancies. Aim of this study was to assess the current evidence on extracapsular LNI as a prognostic factor for recurrence in gastrointestinal malignancies.
  
  
  METHODS
  The Cochrane Database of systematic reviews, the Cochrane central register of controlled trials, and MEDLINE databases were searched using a combination of keywords relating to extracapsular LNI in gastrointestinal malignancies. Primary outcome parameters were incidence of extracapsular LNI and overall five-year survival rates.
  
  
  RESULTS
  Fourteen manuscripts were included, concerning seven oesophageal, three gastric, one colorectal, and three rectal cancer series with a total of 1528 node positive patients. The pooled incidence of extracapsular LNI was 57% (95% CI: 53-61%) for oesophageal cancer, 41% (95% CI: 36-47%) for gastric cancer, and 35% (95% CI: 31-40%) for rectal cancer. In nine of the 14 studies a multivariate analysis was performed. In eight of these nine studies extracapsular LNI was identified as an independent risk factor for recurrence.
  
  
  CONCLUSIONS
  Extracapsular LNI is a common phenomenon in patients with gastrointestinal malignancies. It identifies a subgroup of patients with a significantly worse long-term survival. This systematic review highlights the importance of assessing extracapsular LNI as a valuable prognostic factor. Pathologists and clinicians should be aware of this important feature.
authors.affiliation: Department of Surgery, Academic Medical Centre, Post-box 22660, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. j.wind@amc.uva.nl
authors.forename: J
authors.initials: J
authors.lastname: Wind
authors.forename: S M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: F J W
authors.initials: FJ
authors.lastname: Ten Kate
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D016009:Chi-Square Distribution; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate