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Colorectal cancer: more lymph nodes not necessarily "better"?

Posted Jul 22 2009 12:00am

I pulled the following from ASCO Daily News.  I haven't read the full paper myself and, although not surprised by this study's results, I think this will likely be a good paper to use in discussions with surgical and oncologist colleagues.

HealthDay (7/20, Thomas) reported, "More isn't necessarily better when it comes to surgically removing lymph nodes to diagnose late-stage colorectal cancer," according to a study published July 20 in the Archives of Surgery. The World Congress of Gastroenterology recommends removing "at least 12 lymph nodes during surgery for colorectal cancer," a standard that has been "widely adopted as a measure of quality in surgical practices."

        That benchmark was also adopted by "the American Society of Clinical Oncology, and several insurers," MedPage Today (7/20, Bankhead) reported. For the current study, researchers examined data on "701 consecutive colorectal cancer patients, 553 of whom had surgery before the initiative and 148 patients who had surgery after the program began." The study showed that while "the mean lymph-node count increased from 12.8 before the initiative to 17.3 afterward," the "number of resections with at least 12 nodes retrieved" also increased "from 53 percent to 71.6 percent." But, "the proportion of patients with stage III disease tended to decrease from 36.9 percent prior to the institutional initiative to 32.4 percent for the later patient group."

Numerous studies repeat that lymph node recovery is a complex, multifactorial process dependent on myriad factors--while reporting widely varying absolute numbers for being considered "adequate."

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