title: Colorectal cancer and lymph nodes: the obsession with the number 12.
abstract: Lymphadenectomy of colorectal cancer is a decisive factor for the prognostic and therapeutic staging of the patient. For over 15 years, we have asked ourselves if the minimum number of 12 examined lymph nodes (LNs) was sufficient for the prevention of understaging. The debate is certainly still open if we consider that a limit of 12 LNs is still not the gold standard mainly because the research methodology of the first studies has been criticized. Moreover many authors report that to date both in the United States and Europe the number "12" target is uncommon, not adequate, or accessible only in highly specialised centres. It should however be noted that both the pressing nature of the debate and the dissemination of guidelines have been responsible for a trend that has allowed for a general increase in the number of LNs examined. There are different variables that can affect the retrieval of LNs. Some, like the surgeon, the surgery, and the pathology exam, are without question modifiable; however, other both patient and disease-related variables are non-modifiable and pose the question of whether the minimum number of examined LNs must be individually assigned. The lymph nodal ratio, the sentinel LNs and the study of the biological aspects of the tumor could find valid application in this field in the near future.
authors.affiliation: Giovanni Li Destri, Isidoro Di Carlo, Roberto Scilletta, Beniamino Scilletta, Stefano Puleo, Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, 95123 Catania, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Li Destri
authors.affiliation: Giovanni Li Destri, Isidoro Di Carlo, Roberto Scilletta, Beniamino Scilletta, Stefano Puleo, Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, 95123 Catania, Italy.
authors.forename: Isidoro
authors.initials: I
authors.lastname: Di Carlo
authors.affiliation: Giovanni Li Destri, Isidoro Di Carlo, Roberto Scilletta, Beniamino Scilletta, Stefano Puleo, Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, 95123 Catania, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scilletta
authors.affiliation: Giovanni Li Destri, Isidoro Di Carlo, Roberto Scilletta, Beniamino Scilletta, Stefano Puleo, Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, 95123 Catania, Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: Scilletta
authors.affiliation: Giovanni Li Destri, Isidoro Di Carlo, Roberto Scilletta, Beniamino Scilletta, Stefano Puleo, Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, 95123 Catania, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Puleo
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D005060:Europe; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States
keywords: Colorectal cancer; Lymph node count; Lymph node ratio; Lymphadenectomy; Staging