Cristians A Gonzalez, MD1, Jung-Myun Kwak, MD1, Talitha Mendes, MD2, Carlos Veo, MD2, Maximiliano Cadamuro Neto, MD2, Marcos Denadai, MD2, Armando Melani, MD2, Bernard Dallemagne, MD3, Jacques Marescaux, MD, FACS, HON, FRCS, HON, FJSES, HON, FASA3, Luis Romagnolo, MD2. 1IHU-Strasbourg Institute for Image-Guided Surgery (Strasbourg, France), 2Barretos Cancer Hospital (IRCAD LATIN AMERICA – Sao Paulo, Brazil), 3IRCAD, Research Institute against Cancer of the Digestive System (Strasbourg, France)
INTRODUCTION: Accurate staging is essential to estimate the prognosis of patients with colorectal cancer (CRC) and lymph node evaluation is key to determine it. In non-metastatic CRC, the number of harvested lymph nodes is the strongest prognostic factor for outcome and survival. Additionally, it is thought that a higher lymph node yield may be representative of a higher quality of surgical care. Due to the importance of the association between lymph node evaluation and outcome in CRC, it is necessary to evaluate factors which may affect lymph node harvest.
METHODS AND PROCEDURES: In order to determine the influence of different patient-related factors, of tumor characteristics and operative parameters impacting the quality of oncological lymph node dissection and harvesting intraoperatively, a prospective collection and retrospective analysis of all cases of colorectal cancer patients operated on in the Digestive Surgery Department at Barretos Cancer Hospital (IRCAD LATIN AMERICA, Sao Paulo, Brazil) was performed between July 2015 and February 2017.
RESULTS: Over the abovementioned period, 640 radical surgeries for colorectal cancer were performed, 294 (46%) of which were performed in female patients and 346 (54%) in male patients. Lesions were located as follows: right colon (99 cases, 15.5%), transverse colon (19 cases, 3%), left colon (30 cases, 4.8%), sigmoid colon (163 cases, 25.6%) and rectum (325 cases, 51.1%). Seventy percent of patient cases were performed laparoscopically with a conversion rate of 3.6%. The mean number of resected nodes according to tumor location was the following: 19 for the right colon, 20 for the transverse colon, 24 for the left colon, 20 for the sigmoid colon and rectum. Preoperative radiotherapy (p<0.001) has a negative impact on the number of dissected nodes. Other patient-related factors such as age, gender and BMI have no influence on this. There was no relationship between tumor-specific factors and the quality of node dissection. Finally, operative time (p=0.021) is the only technique-specific factor affecting the radicality of surgical resection in patients with colorectal cancer, probably as a reflection of more surgically complex cases.
CONCLUSION: Preoperative radiotherapy and operative time are factors which are often interrelated, have a significant impact on the number of harvested nodes. The relationship of these findings with the outcome and survival of CRC patients is yet to be determined.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86788
Program Number: P227
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster