title: T1 colon cancer in the era of screening: risk factors and treatment.
abstract: BACKGROUND
  The aim of this study was to identify risk factors for lymph node positivity in T1 colon cancer and to carry out a surgical quality assurance audit.
  
  
  METHODS
  The sample consisted of consecutive patients treated for early-stage colon lesions in 15 colorectal referral centres between 2011 and 2014. The study investigated 38 factors grouped into four categories: demographic information, preoperative data, indications for surgery and post-operative data. A univariate and multivariate logistic regression analysis was performed to analyze the significance of each factor both in terms of lymph node (LN) harvesting and LN metastases.
  
  
  RESULTS
  Out of 507 patients enrolled, 394 patients were considered for analysis. Thirty-five (8.91%) patients had positive LN. Statistically significant differences related to total LN harvesting were found in relation to central vessel ligation and segmental resections. Cumulative distribution demonstrated that the rate of positive LN increased starting at 12 LN harvested and reached a plateau at 25 LN.
  
  
  CONCLUSIONS
  Some factors associated with an increase in detection of positive LN were identified. However, further studies are needed to identify more sensitive markers and avoid surgical overtreatment. There is a need to raise the minimum LN count and to use the LN count as an indicator of surgical quality.
authors.affiliation: Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy. bianco.bar@tin.it.
authors.forename: F
authors.initials: F
authors.lastname: Bianco
authors.affiliation: Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Franciscis
authors.affiliation: Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Belli
authors.affiliation: Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Falato
authors.affiliation: Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fusco
authors.affiliation: Department of Emergency and Organ Transplantation, Aldo Moro University Bari, Bari, Italy.
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
authors.affiliation: Department of Coloproctology, Sanremo Hospital, Sanremo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Amato
authors.affiliation: Department of General Surgery, Ospedale Carlo Poma Mantova, Mantua, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Asteria
authors.affiliation: Gastrointestinal Medical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Avallone
authors.affiliation: Departement of General Surgery, Galliera Hospital, Genoa, Italy.
authors.forename: G A
authors.initials: GA
authors.lastname: Binda
authors.affiliation: Department of General Surgery, Ospedale Carlo Poma Mantova, Mantua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Boccia
authors.affiliation: Department of Coloproctology, Sanremo Hospital, Sanremo, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Buzzo
authors.affiliation: Department of Colon and Rectal Surgery, Humanitas Research Hospital -IRCCS, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Carvello
authors.affiliation: Department of Surgical Sciences, Fondazione Policlinico Universitario Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Coco
authors.affiliation: Colorectal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Delrio
authors.affiliation: Division of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: De Nardi
authors.affiliation: Department of Emergency and Organ Transplantation, Aldo Moro University Bari, Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Lena
authors.affiliation: Department of Surgical Oncology, Candiolo Cancer Institute, IRCCS, Candiolo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Failla
authors.affiliation: Division of Colorectal and Pelvic Surgery, Sapienza University, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: La Torre
authors.affiliation: Division of Colorectal and Pelvic Surgery, Sapienza University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: La Torre
authors.affiliation: Department of General Surgery I, Azienda Ospedaliera-Università degli Studi di Padova, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lemma
authors.affiliation: Department of General Surgery, Università Campus Bio-medico, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Luffarelli
authors.affiliation: Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Manca
authors.affiliation: Department of General Surgery I, Azienda Ospedaliera-Università degli Studi di Padova, Padua, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Maretto
authors.affiliation: Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Marino
authors.affiliation: Department of Surgical Oncology, Candiolo Cancer Institute, IRCCS, Candiolo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muratore
authors.affiliation: Department of General Surgery, Ospedale Carlo Poma Mantova, Mantua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pascariello
authors.affiliation: Department of General Surgery I, Azienda Ospedaliera-Università degli Studi di Padova, Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pucciarelli
authors.affiliation: Colorectal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Rega
authors.affiliation: Department of General Surgery, Università Campus Bio-medico, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ripetti
authors.affiliation: Department of Surgical Sciences, Fondazione Policlinico Universitario Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: Departement of General Surgery, Galliera Hospital, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Serventi
authors.affiliation: Department of Colon and Rectal Surgery, Humanitas Research Hospital -IRCCS, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Spinelli
authors.affiliation: Pathology Unit- Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tatangelo
authors.affiliation: Department of General Surgery I, Azienda Ospedaliera-Università degli Studi di Padova, Padua, Italy.
authors.forename: E D L
authors.initials: ED
authors.lastname: Urso
authors.affiliation: Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Romano
mesh_terms: D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008485:Medical Audit; D000069342:Medical Overuse / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Early-stage colon cancer; Lymph node metastases; Quality assurance; Screening