F Bianco1, S De Franciscis2, A Belli2, A Falato2, R Fusco3, D F Altomare4, A Amato5, C R Asteria6, A Avallone7, G A Binda8, L Boccia6, P Buzzo5, M Carvello9, C Coco10, P Delrio11, P De Nardi12, M Di Lena4, A Failla13, F La Torre14, M La Torre14, M Lemma15, P Luffarelli16, G Manca17, I Maretto15, F Marino17, A Muratore13, A Pascariello6, S Pucciarelli15, D Rega11, V Ripetti16, G Rizzo10, A Serventi8, A Spinelli9, F Tatangelo18, E D L Urso15, G M Romano2. 1. Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy. bianco.bar@tin.it. 2. Abdominal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy. 3. Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS, Naples, Italy. 4. Department of Emergency and Organ Transplantation, Aldo Moro University Bari, Bari, Italy. 5. Department of Coloproctology, Sanremo Hospital, Sanremo, Italy. 6. Department of General Surgery, Ospedale Carlo Poma Mantova, Mantua, Italy. 7. Gastrointestinal Medical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy. 8. Departement of General Surgery, Galliera Hospital, Genoa, Italy. 9. Department of Colon and Rectal Surgery, Humanitas Research Hospital -IRCCS, Milan, Italy. 10. Department of Surgical Sciences, Fondazione Policlinico Universitario Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy. 11. Colorectal Surgical Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy. 12. Division of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy. 13. Department of Surgical Oncology, Candiolo Cancer Institute, IRCCS, Candiolo, Italy. 14. Division of Colorectal and Pelvic Surgery, Sapienza University, Rome, Italy. 15. Department of General Surgery I, Azienda Ospedaliera-Università degli Studi di Padova, Padua, Italy. 16. Department of General Surgery, Università Campus Bio-medico, Rome, Italy. 17. Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy. 18. Pathology Unit- Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale" IRCCS, Naples, Italy.
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.
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: Wouter Willaert; Marc Mareel; Dirk Van De Putte; Yves Van Nieuwenhove; Piet Pattyn; Wim Ceelen Journal: Cancer Treat Rev Date: 2013-09-25 Impact factor: 12.111
Authors: Marco La Torre; Giuseppe Nigri; Federica Mazzuca; Mario Ferri; Andrea Botticelli; Laura Lorenzon; Emanuela Pilozzi; Vincenzo Ziparo Journal: J Gastrointestin Liver Dis Date: 2014-09 Impact factor: 2.008
Authors: Deborah A Fisher; Amandeep K Shergill; Dayna S Early; Ruben D Acosta; Vinay Chandrasekhara; Krishnavel V Chathadi; G Anton Decker; John A Evans; Robert D Fanelli; Kimberly Q Foley; Lisa Fonkalsrud; Joo Ha Hwang; Terry Jue; Mouen A Khashab; Jenifer R Lightdale; V Raman Muthusamy; Shabana F Pasha; John R Saltzman; Ravi Sharaf; Brooks D Cash Journal: Gastrointest Endosc Date: 2013-05-07 Impact factor: 9.427
Authors: Paris P Tekkis; Jason J Smith; Alexander G Heriot; Ara W Darzi; Michael R Thompson; Jeffrey D Stamatakis Journal: Dis Colon Rectum Date: 2006-11 Impact factor: 4.585
Authors: Cornelis J H van de Velde; Petra G Boelens; Josep M Borras; Jan-Willem Coebergh; Andres Cervantes; Lennart Blomqvist; Regina G H Beets-Tan; Colette B M van den Broek; Gina Brown; Eric Van Cutsem; Eloy Espin; Karin Haustermans; Bengt Glimelius; Lene H Iversen; J Han van Krieken; Corrie A M Marijnen; Geoffrey Henning; Jola Gore-Booth; Elisa Meldolesi; Pawel Mroczkowski; Iris Nagtegaal; Peter Naredi; Hector Ortiz; Lars Påhlman; Philip Quirke; Claus Rödel; Arnaud Roth; Harm Rutten; Hans J Schmoll; Jason J Smith; Pieter J Tanis; Claire Taylor; Arne Wibe; Theo Wiggers; Maria A Gambacorta; Cynthia Aristei; Vincenzo Valentini Journal: Eur J Cancer Date: 2013-10-31 Impact factor: 9.162