Colorectal cancer and lymph nodes:The obsession with the number 12

来源 :World Journal of Gastroenterology | 被引量 : 0次 | 上传用户:coldblast
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Lymphadenectomy of colorectal cancer is a decisive factor for the prognostic and therapeutic staging of the patient.For over 15 years,we have asked ourselves if the minimum number of 12 examined lymph nodes(LNs)was sufficient for the prevention of understaging.The debate is certainly still open if we consider that a limit of 12 LNs is still not the gold standard mainly because the research methodology of the first studies has been criticized.Moreover many authors report that to date both in the United States and Europe the number“12”target is uncommon,not adequate,or accessible only in highly specialised centres.It should however be noted that both the pressing nature of the debate and the dissemination of guidelines have been responsible for a trend that has allowed for a general increase in the number of LNs examined.There are different variables that can affect the retrieval of LNs.Some,like the surgeon,the surgery,and the pathology exam,are without question modifiable;however,other both patient and disease-related variables are non-modifiable and pose the question of whether the minimum number of examined LNs must be individually assigned.The lymph nodal ratio,the sentinel LNs and the study of the biological aspects of the tumor could find valid application in this field in the near future. Lymphadenectomy of colorectal cancer is a decisive factor for the prognostic and therapeutic staging of the patient. For over 15 years, we have asked ourselves if the minimum number of 12 surveying lymph nodes (LNs) was sufficient for the prevention of understaging. Debate. certainly still open if we consider that a limit of 12 LNs is still not the gold standard primarily because the research methodology of the first studies has been criticized. More than one authors report that to date both in the United States and Europe the number “12 ”target is uncommon, not adequate, or accessible only in highly specialized centers. It should be noted that both the pressing nature of the debate and the dissemination of guidelines have been responsible for a trend that has allowed for a general increase in the number of LNs examined.There are different variables that can affect the retrieval of LNs.Some, like the surgeon, the surgery, and the pathology exam, are without question modifiable; however, oth er both patient and disease-related variables are non-modifiable and pose the question of whether the minimum number of examined LNs must be individually assigned. the lymph nodal ratio, the sentinel LNs and the study of the biological aspects of the tumor could find valid application in this field in the near future
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