Sunil V Patel1, Sanjay V B Patel1, Muriel Brackstone2. 1. The Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ont. 2. The Department of Surgery, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ont.
Abstract
BACKGROUND: It has been suggested that inadequate lymph node harvest may result in pathologically understaged or indeterminate staging of patients with colorectal cancer (CRC). We compared the adequacy of nodal staging in patients undergoing emergency surgery compared with elective surgery for CRC. METHODS: Using a prospectively collected CRC surgery database at a tertiary care centre, we performed a cohort study. The mean number of lymph nodes harvested and the proportion of patients who had inadequate staging (< 12 nodes harvested) were compared between emergency and elective surgery cohorts. Our analysis was adjusted for tumour site, type of resection, surgical training and pathologic stage. RESULTS: A total of 1279 of 1356 (94%) enrolled patients had nodal data available for analysis; 161 (13%) patients had emergency surgery and 1118 (87%) had elective surgery. The mean number of nodes removed was higher in the emergency surgery group (mean difference +2.8, 95% confidence interval [CI] 0.6-5.1, p = 0.012). The proportion of patients with inadequate nodal staging did not differ between groups (emergent 16%, elective 17%, p = 0.79). The odds of adequate nodal staging, adjusting for site, type of resection, training and stage was no different between groups (OR 0.80, 95% CI 0.47-1.35, p = 0.41). CONCLUSION: The evidence does not support the common belief that emergency surgery is more commonly understaged in CRC. Our data suggest emergency surgery resulted in a significant increase in the average number of nodes harvested, with no difference in inadequate nodal staging.
BACKGROUND: It has been suggested that inadequate lymph node harvest may result in pathologically understaged or indeterminate staging of patients with colorectal cancer (CRC). We compared the adequacy of nodal staging in patients undergoing emergency surgery compared with elective surgery for CRC. METHODS: Using a prospectively collected CRC surgery database at a tertiary care centre, we performed a cohort study. The mean number of lymph nodes harvested and the proportion of patients who had inadequate staging (< 12 nodes harvested) were compared between emergency and elective surgery cohorts. Our analysis was adjusted for tumour site, type of resection, surgical training and pathologic stage. RESULTS: A total of 1279 of 1356 (94%) enrolled patients had nodal data available for analysis; 161 (13%) patients had emergency surgery and 1118 (87%) had elective surgery. The mean number of nodes removed was higher in the emergency surgery group (mean difference +2.8, 95% confidence interval [CI] 0.6-5.1, p = 0.012). The proportion of patients with inadequate nodal staging did not differ between groups (emergent 16%, elective 17%, p = 0.79). The odds of adequate nodal staging, adjusting for site, type of resection, training and stage was no different between groups (OR 0.80, 95% CI 0.47-1.35, p = 0.41). CONCLUSION: The evidence does not support the common belief that emergency surgery is more commonly understaged in CRC. Our data suggest emergency surgery resulted in a significant increase in the average number of nodes harvested, with no difference in inadequate nodal staging.
Authors: Nancy N Baxter; Dan J Virnig; David A Rothenberger; Arden M Morris; Jose Jessurun; Beth A Virnig Journal: J Natl Cancer Inst Date: 2005-02-02 Impact factor: 13.506
Authors: Chris Twelves; Alfred Wong; Marek P Nowacki; Markus Abt; Howard Burris; Alfredo Carrato; Jim Cassidy; Andrés Cervantes; Jan Fagerberg; Vassilis Georgoulias; Fares Husseini; Duncan Jodrell; Piotr Koralewski; Hendrik Kröning; Jean Maroun; Norbert Marschner; Joseph McKendrick; Marek Pawlicki; Riccardo Rosso; Johannes Schüller; Jean-François Seitz; Borut Stabuc; Jerzy Tujakowski; Guy Van Hazel; Jerzy Zaluski; Werner Scheithauer Journal: N Engl J Med Date: 2005-06-30 Impact factor: 91.245
Authors: Al B Benson; Deborah Schrag; Mark R Somerfield; Alfred M Cohen; Alvaro T Figueredo; Patrick J Flynn; Monika K Krzyzanowska; Jean Maroun; Pamela McAllister; Eric Van Cutsem; Melissa Brouwers; Manya Charette; Daniel G Haller Journal: J Clin Oncol Date: 2004-06-15 Impact factor: 44.544
Authors: Sharlene Gill; Charles L Loprinzi; Daniel J Sargent; Stephan D Thomé; Steven R Alberts; Daniel G Haller; Jacqueline Benedetti; Guido Francini; Lois E Shepherd; Jean Francois Seitz; Roberto Labianca; Wei Chen; Stephen S Cha; Michael P Heldebrant; Richard M Goldberg Journal: J Clin Oncol Date: 2004-04-05 Impact factor: 44.544
Authors: Gianluca Costa; Laura Lorenzon; Giulia Massa; Barbara Frezza; Mario Ferri; Pietro Fransvea; Paolo Mercantini; Maria Cristina Giustiniani; Genoveffa Balducci Journal: Int J Colorectal Dis Date: 2017-07-28 Impact factor: 2.571
Authors: Kerollos Nashat Wanis; Michael Ott; Julie Ann M Van Koughnett; Patrick Colquhoun; Muriel Brackstone Journal: Int J Colorectal Dis Date: 2018-06-26 Impact factor: 2.571
Authors: Gianluca Costa; Barbara Frezza; Pietro Fransvea; Giulia Massa; Mario Ferri; Paolo Mercantini; Genoveffa Balducci; Antonio Buondonno; Aldo Rocca; Graziano Ceccarelli Journal: Open Med (Wars) Date: 2019-10-02