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Nodal counts and the extent of lymphadenectomy in colorectal cancer: a systematic review

Wouter Willaert (UGent) , Dirk Van de Putte (UGent) , Katrien Van Renterghem (UGent) , Yves Van Nieuwenhove (UGent) , Piet Pattyn (UGent) and Wim Ceelen (UGent)
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Abstract
Introduction: Controversy persists on the use of lymph node counts as a quality indicator in colorectal cancer (CRC), and on the extent of lymphadenectomy. Here, we performed a systematic literature review on this topic. Methods: A systematic literature review was performed using MEDLINE, Web of Knowledge and Ovid. Search terms were: [colo* AND nod* AND (adenocarcinoma or cancer)]. Results: The biology of lymphatic tumour spread in colorectal cancer suggests that, rather than a late stepwise phenomenon, lymphatic spread can occur early in the course of tumourigenesis. Lymph node harvest is subject to a range of confounding variables, which can be classified into 5 major groups involving the patient, the tumour, the surgeon, the hospital, and the pathologist. The relation between nodal counts, nodal positivity rate, and survival is inconsistent. Extensive surgical lymphadenectomy such as in total mesocolic excision has no proven effect on survival. Recently, the ratio of positive nodes over total number examined (lymph node ratio, LNR) was introduced as a more precise prognostic marker compared to positive node count in stage III disease. Conclusions: The use of a nodal count threshold as a quality indicator in CRC is questionable. The aim of lymph node resection and examination should be conceived in terms of diagnosis, staging, prognosis and regional control and has no or little therapeutic value. The benefit of extensive lymphadenectomy in CRC remains undefined and should be the subject of prospective comparative trials.

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MLA
WILLAERT, WOUTER, DIRK VAN DE PUTTE, KATRIEN VAN RENTERGHEM, et al. “Nodal Counts and the Extent of Lymphadenectomy in Colorectal Cancer: a Systematic Review.” Belgian Surgical Week, Abstracts. 2013. Print.
APA
WILLAERT, W., VAN DE PUTTE, D., VAN RENTERGHEM, K., Van Nieuwenhove, Y., Pattyn, P., & Ceelen, W. (2013). Nodal counts and the extent of lymphadenectomy in colorectal cancer: a systematic review. Belgian Surgical Week, Abstracts. Presented at the 14th Belgian Surgical Week.
Chicago author-date
WILLAERT, WOUTER, DIRK VAN DE PUTTE, KATRIEN VAN RENTERGHEM, Yves Van Nieuwenhove, Piet Pattyn, and Wim Ceelen. 2013. “Nodal Counts and the Extent of Lymphadenectomy in Colorectal Cancer: a Systematic Review.” In Belgian Surgical Week, Abstracts.
Chicago author-date (all authors)
WILLAERT, WOUTER, DIRK VAN DE PUTTE, KATRIEN VAN RENTERGHEM, Yves Van Nieuwenhove, Piet Pattyn, and Wim Ceelen. 2013. “Nodal Counts and the Extent of Lymphadenectomy in Colorectal Cancer: a Systematic Review.” In Belgian Surgical Week, Abstracts.
Vancouver
1.
WILLAERT W, VAN DE PUTTE D, VAN RENTERGHEM K, Van Nieuwenhove Y, Pattyn P, Ceelen W. Nodal counts and the extent of lymphadenectomy in colorectal cancer: a systematic review. Belgian Surgical Week, Abstracts. 2013.
IEEE
[1]
W. Willaert, D. Van de Putte, K. Van Renterghem, Y. Van Nieuwenhove, P. Pattyn, and W. Ceelen, “Nodal counts and the extent of lymphadenectomy in colorectal cancer: a systematic review,” in Belgian Surgical Week, Abstracts, Oostende, Belgium, 2013.
@inproceedings{5866093,
  abstract     = {Introduction: Controversy persists on the use of lymph node counts as a quality indicator in colorectal cancer (CRC), and on the extent of lymphadenectomy. Here, we performed a systematic literature review on this topic.
Methods: A systematic literature review was performed using MEDLINE, Web of Knowledge and Ovid. Search terms were: [colo* AND nod* AND (adenocarcinoma or cancer)].
Results: The biology of lymphatic tumour spread in colorectal cancer suggests that, rather than a late stepwise phenomenon, lymphatic spread can occur early in the course of tumourigenesis. Lymph node harvest is subject to a range of confounding variables, which can be classified into 5 major groups involving the patient, the tumour, the surgeon, the hospital, and the pathologist. The relation between nodal counts, nodal positivity rate, and survival is inconsistent. Extensive surgical lymphadenectomy such as in total mesocolic excision has no proven effect on survival. Recently, the ratio of positive nodes over total number examined (lymph node ratio, LNR) was introduced as a more precise prognostic marker compared to positive node count in stage III disease.
Conclusions: The use of a nodal count threshold as a quality indicator in CRC is questionable. The aim of lymph node resection and examination should be conceived in terms of diagnosis, staging, prognosis and regional control and has no or little therapeutic value. The benefit of extensive lymphadenectomy in CRC remains undefined and should be the subject of prospective comparative trials.},
  author       = {Willaert, Wouter and Van de Putte, Dirk and Van Renterghem, Katrien and Van Nieuwenhove, Yves and Pattyn, Piet and Ceelen, Wim},
  booktitle    = {Belgian Surgical Week, Abstracts},
  language     = {eng},
  location     = {Oostende, Belgium},
  title        = {Nodal counts and the extent of lymphadenectomy in colorectal cancer: a systematic review},
  year         = {2013},
}