Impact of Schwartz enhanced visualization solution on staging colorectal cancer and clinicopathological features associated with lymph node count.
BACKGROUND
Stage-specific survival for colon cancer improves when more lymph nodes are reported in the surgical specimen. This has led to a minimum standard of identifying 12 lymph nodes as a quality indicator.


OBJECTIVE
The aim of this study was to determine whether the addition of Schwartz solution increases node yield and impacts pathologic staging.


METHODS
This is a prospective cohort study.


METHODS
The study was conducted in an academic medical center.


METHODS
Included were 104 consecutive patients with colorectal cancer.


METHODS
Lymph node counts before and after specimen treatment with Schwartz solution and incidence of upstaging were measured.


RESULTS
An additional 20 minutes (interquartile range, 15-40 minutes) was spent searching for lymph nodes, increasing the median number of nodes from 22.5 to 29.0 nodes. However, only 1 patient was upstaged. Schwartz solution decreased the number of specimens with less than 12 lymph nodes from 15 to 6. The following factors were associated with Schwartz solution leading to the detection of additional nodes: number of nodes detected initially with formalin only (p < 0.000), mesenteric fat volume (p < 0.000), mesenteric fat weight (p < 0.000), length of specimen (p < 0.016), tumor greatest dimension (p < 0.016), patient body surface area (p < 0.034), and patient age (p < 0.003).


CONCLUSIONS
Clinical data for this study were obtained retrospectively and were not available for all of the patients.


CONCLUSIONS
Although Schwartz solution increased the number of nodes detected in 95% of patients and improved compliance with the 12-node standard for colon resection, there was minimal impact on cancer staging. Upstaging is unlikely to explain the increase in overall survival in patients with higher lymph node counts, casting doubt on the validity of this process measure as a meaningful quality indicator. Rather, the lymph node count may be a reflection of inherent tumor biology or host-related factors.
Department of Surgery, University of Vermont College of Medicine, Burlington, VT 05405, USA.
Brandon
B
Chapman
Cherie
C
Paquette
Chelsea
C
Tooke
Michelle
M
Schwartz
Turner
T
Osler
Donald
D
Weaver
Rebecca
R
Wilcox
Neil
N
Hyman
D019342:Acetic Acid; D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D000431:Ethanol; D005260:Female; D005404:Fixatives; D005557:Formaldehyde; D006801:Humans; D007202:Indicators and Reagents; D050152:Intra-Abdominal Fat; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D012997:Solvents
D005404:Fixatives; D007202:Indicators and Reagents; D012997:Solvents; D005557:Formaldehyde; D000431:Ethanol; D019342:Acetic Acid