Hamza Ameer, Sakhi Ramen, Khawar Sidrah, Alrajjal Ahmed, Edens Jacob, Khurram Muhammad Siddique, Khan Uqba, Szpunar Susanna, Mazzara Paul
St. John Hospital and Medical Center, Detroit, MI, USA.
Vanderbilt University Medical Center, Nashville, TN, USA.
Gastroenterol Res Pract. 2018 Apr 2;2018:1985031. doi: 10.1155/2018/1985031. eCollection 2018.
As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.
与其他恶性肿瘤一样，淋巴结转移是结直肠癌重要的分期因素和预后因素。根据美国监测、流行病学和最终结果（SEER）癌症登记数据库，所有pT分期中，受累淋巴结数量与5年总生存率降低直接相关。国家质量论坛规定，手术切除标本中至少有12枚淋巴结是评估结直肠癌的关键质量指标之一。因此，获取至少12枚淋巴结是评估结直肠癌最广泛接受的标准。由于这是一个公认的质量标准，当最初的淋巴结计数少于12枚时，通常会对大体标本进行第二次淋巴结清扫尝试，这会导致报告延迟和额外费用。然而，这是一个随意确定的数字，并非基于任何确凿的科学证据。我们决定研究提交额外淋巴结所付出的额外努力和费用是否对病理淋巴结分期（pN）有任何影响。我们共确定了99例结直肠癌结肠切除术病例，其中病理学家在初次检查后随后提交了额外的淋巴结。初次检查时的平均淋巴结计数为8.3±7.5枚，提交额外切片后增至14.6±8.0枚。达到12枚淋巴结目标的病例数从14例增加到69例。对额外淋巴结的检查导致5例病例的病理分期上调（pN）。对大体标本进行重新检查并提交额外淋巴结可能在少数病例中提供更准确的分期。肠系膜脂肪的详尽提交或脂肪清除方法是否合理，仍需进一步研究。
