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dc.contributor.authorMcDonald, James Ren_GB
dc.contributor.authorRenehan, Andrew Gen_GB
dc.contributor.authorO'Dwyer, Sarah Ten_GB
dc.contributor.authorHaboubi, Nen_GB
dc.date.accessioned2012-06-25T13:19:03Z
dc.date.available2012-06-25T13:19:03Z
dc.date.issued2012-01-27
dc.identifier.citationLymph node harvest in colon and rectal cancer: Current considerations. 2012, 4 (1):9-19 World J Gastrointest Surgen_GB
dc.identifier.issn1948-9366
dc.identifier.pmid22347537
dc.identifier.doi10.4240/wjgs.v4.i1.9
dc.identifier.urihttp://hdl.handle.net/10541/230535
dc.description.abstractThe prognostic significance of identifying lymph node (LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease. An established body of evidence exists, demonstrating an association between a higher total LN count and improved survival, particularly for node negative colon cancer. In node positive disease, however, the lymph node ratios may represent a better prognostic indicator, although the impact of this on clinical treatment has yet to be universally established. By extension, strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging. However, debate prevails as to whether or not these extrapolations are clinically relevant, particularly when very high LN counts are sought. Current guidelines recommend a minimum of 12 nodes harvested as the standard of care, yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival. Findings from modern treatments, including down-staging in rectal cancer using pre-operative chemoradiotherapy, paradoxically suggest that lower LN count, or indeed complete absence of LNs, are associated with improved survival; implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate. The pursuit of a sufficient LN harvest represents good clinical practice; however, recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little influence on modern approaches to treatment.
dc.language.isoenen
dc.rightsArchived with thanks to World journal of gastrointestinal surgeryen_GB
dc.titleLymph node harvest in colon and rectal cancer: Current considerations.en
dc.typeArticleen
dc.contributor.departmentDepartment of Surgery, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom.en_GB
dc.identifier.journalWorld Journal of Gastrointestinal Surgeryen_GB
html.description.abstractThe prognostic significance of identifying lymph node (LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease. An established body of evidence exists, demonstrating an association between a higher total LN count and improved survival, particularly for node negative colon cancer. In node positive disease, however, the lymph node ratios may represent a better prognostic indicator, although the impact of this on clinical treatment has yet to be universally established. By extension, strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging. However, debate prevails as to whether or not these extrapolations are clinically relevant, particularly when very high LN counts are sought. Current guidelines recommend a minimum of 12 nodes harvested as the standard of care, yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival. Findings from modern treatments, including down-staging in rectal cancer using pre-operative chemoradiotherapy, paradoxically suggest that lower LN count, or indeed complete absence of LNs, are associated with improved survival; implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate. The pursuit of a sufficient LN harvest represents good clinical practice; however, recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little influence on modern approaches to treatment.


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