Ballanamada Appaiah Nikhil Nanjappa, Rafaih Iqbal Muhammad, Kafayat Lesi Omotara, Medappa Maruvanda Sushmitha, Cai Wenyi, Rajakumar Andrien, Khan Laeeq
General and Colorectal Surgery, Basildon and Thurrock University Hospital, Basildon, GBR.
Paediatrics, M. S. Ramaiah Medical College, Bangalore, IND.
Cureus. 2021 Oct 29;13(10):e19115. doi: 10.7759/cureus.19115. eCollection 2021 Oct.
Background Colorectal cancer (CRC) is a significant cause of cancer-related deaths worldwide and is the third most common cause of cancer deaths in the UK. The status of lymph node metastasis is a key factor for predicting the prognosis of a patient's CRC. Aims This study aimed to analyze the demographics of left-sided colonic and rectal cancers at a single institution. We looked closely at the correlation between patient age and various histological factors. We tried to find any significant difference in lymph node yield (LNY) between laparoscopic surgery (LS) and open surgery (OS). We aimed to identify any statistical correlation between LNY and lymph node positivity (LNP) with other patient, surgical and histopathological features. Methodology This is a retrospective, non-interventional review of consecutive patients who underwent left-sided colonic and rectal cancer resections over a three-year period between 01 April 2018 and 31 March 2021. Descriptive and inferential statistical analyses were used. Chi-squared / Fisher exact test was used on a categorical scale between two or more groups and non-parametric setting for qualitative data analysis. Results A total of 102 patients were included in the study. No statistical correlation was found between the age of the patient with the LNY, LNP, location of the tumor, type, and urgency of the operation. LNY ranged between one and 43 nodes (median (interquartile range (IQR)) 17, 8). There was no statistically significant difference in LNY between laparoscopic surgery (LS) and open surgery (OS) (p=0.1449). Significant statistical correlation was identified between LNP and completeness of resection (CoR) (p=0.039), vascular invasion (VI) (p<0.001), perineural invasion (PI) (p<0.001), and circumferential resectional margin involvement (CRMI) (p=0.039). Discussion LNY and LNP are important prognostic indices in colorectal cancer. Patient age, tumor location, the urgency of surgery, and consultant experience did not significantly impact the LNY. Our study showed a positive correlation between LNP and CRMI, VI and PI comparable to literature. Contrary to other studies, we found no statistical significance between LS vs. OS and LNY. Whether 12 nodes per patient is an appropriate level remains controversial.
结直肠癌（CRC）是全球癌症相关死亡的重要原因，在英国是癌症死亡的第三大常见原因。淋巴结转移状况是预测患者结直肠癌预后的关键因素。
本研究旨在分析一家机构中左侧结肠癌和直肠癌的人口统计学特征。我们密切关注患者年龄与各种组织学因素之间的相关性。我们试图找出腹腔镜手术（LS）和开放手术（OS）之间淋巴结收获量（LNY）的任何显著差异。我们旨在确定LNY与淋巴结阳性（LNP）以及其他患者、手术和组织病理学特征之间的任何统计相关性。
这是一项对2018年4月1日至2021年3月31日三年期间接受左侧结肠癌和直肠癌切除术的连续患者进行的回顾性、非干预性研究。使用描述性和推断性统计分析。对两组或多组之间的分类变量使用卡方检验/费舍尔精确检验，对定性数据分析使用非参数方法。
共有102名患者纳入研究。患者年龄与LNY、LNP、肿瘤位置、手术类型和紧急程度之间未发现统计相关性。LNY范围为1至43个淋巴结（中位数（四分位间距（IQR））17，8）。腹腔镜手术（LS）和开放手术（OS）之间的LNY无统计学显著差异（p = 0.1449）。在LNP与切除完整性（CoR）（p = 0.039）、血管侵犯（VI）（p < 0.001）、神经周围侵犯（PI）（p < 0.001）和环周切缘受累（CRMI）（p = 0.039）之间发现了显著的统计相关性。
LNY和LNP是结直肠癌重要的预后指标。患者年龄、肿瘤位置、手术紧急程度和会诊医生经验对LNY没有显著影响。我们的研究表明LNP与CRMI、VI和PI之间存在正相关，与文献一致。与其他研究相反，我们发现LS与OS和LNY之间无统计学意义。每位患者12个淋巴结是否为合适水平仍存在争议。
