title: Linking surgical specimen length and examined lymph nodes in colorectal cancer patients.
abstract: OBJECTIVE
  The number of examined lymph nodes (NLN) was associated with survival of stages II and III colorectal cancer (CRC) patients. Guidelines recommend examining at least 12 lymph nodes. This study investigated the influence of surgical specimen length on lymph node harvest and compliance with international guidelines.
  
  
  METHODS
  This population-based study included 4,724 cases of surgically treated CRC that were diagnosed from 2002 to 2008. Multivariate analyses were performed for the main study variables (age, gender, diagnosis at screening or in symptomatic patients, cancer site, staging, grading, number of positive nodes, neo-adjuvant treatment for rectal cancer, hospital were surgery was performed). Fractional polynomial models investigated the relationship between continuous variables and outcomes.
  
  
  RESULTS
  The NLN increased over time reaching ≥12 NLN in 64% of cases at the end of the study period. More NLN were associated with young age, right colon cancer, pT3-T4 disease, stages II and III and high grade. Fewer NLN were associated with short surgical specimen length and neo-adjuvant treatment in rectal cancer patients. Use of laparoscopy increased sharply over time.
  
  
  CONCLUSIONS
  NLN increased over time in accordance with international guidelines. Surgical specimen length correlated with NLN which may determine therapeutic choices, particularly in stage II colon cancer. When harvested lymph nodes are under 10 in number and all are negative, chemotherapy is always recommended. As specimen lengths <20 cm were associated with a high risk of inadequate NLN counts, patients are at risk of over-treatment.
authors.affiliation: Department of Experimental Medicine, Public Health Section, University of Perugia, Italy; Umbria Cancer Registry, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Stracci
authors.affiliation: Department of Experimental Medicine, Public Health Section, University of Perugia, Italy; Umbria Cancer Registry, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bianconi
authors.affiliation: Umbria Cancer Registry, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Leite
authors.affiliation: Department of Medicine and Surgery, University of Foggia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Liso
authors.affiliation: Umbria Cancer Registry, Italy.
authors.forename: F
authors.initials: F
authors.lastname: La Rosa
authors.affiliation: Department of Surgical and Biomedical Science, Radiation Oncology Section, University of Perugia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Lancellotta
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgical and Biomedical Science, Radiation Oncology Section, University of Perugia, Italy; Radiation Oncology, Perugia General Hospital, Italy. Electronic address: cynthia.aristei@unipg.it.
authors.forename: C
authors.initials: C
authors.lastname: Aristei
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044682:Colon, Ascending; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012737:Sex Factors
keywords: Colorectal tumours; Digestive system surgical procedures; Guidelines adherence; Laparoscopy; Lymph nodes