A report on the lymph node recovery in rectal cancer resection specimens

The American Joint Committee on Cancer presently recommends obtaining at least seven to 14 lymph nodes in radical colon and rectum resections. OBJECTIVES: 1.) To determine the number of lymph nodes recovered in our rectal cancer resection specimens, and 2.) to compare the number of our lymph node harvest with current international recommendations.METHODS: Records of patients who underwent resection for adenocarcinoma of the rectum from 2001 to 2002 were reviewed. From the final pathology report, the number of lymph nodes recovered per specimen was described. This was correlated with the depth of tumor penetration (T) and the intra-operative staging of nodal status (N) by the surgeon. RESULTS: Forty-seven patients underwent resection for adenocarcinoma of the rectum. Ages of patients ranged from 21 to 74 years, with a mean of 52 years. The lymph nodes recovered from the specimens ranged from zero to 15, with an average of 3.1 nodes per specimen. T4 tumors had the highest average rate of lymph node recovery at four nodes per specimen. In 16 patients, metastasis to regional lymph nodes were identified (16/47 or 34 percent node positive). The range of nodes recovered in node positive patients ranged from one to 15, with an average of six nodes. Thirty-one patients were node negative (31/47 or 66 percent). The average nodes recovered per specimen in this group was 1.8, ranging from zero to 12. SUMMARY: From our review, almost 90 percent of our reports did not meet the minimum standard of recovering at least seven lymph nodes in rectal cancer resection specimens. In 94 percent of node negative patients, no sound therapeutic plans could be made due to inadequate lymph node harvest.

Tumor height from the anal verge before and after complete mobilization of the rectum

Rectal tumor height has been observed to increase after complete mobilization.OBJECTIVES: 1.) to measure tumor height in resectable rectal cancers before and after complete mobilization, 2.) to describe changes in tumor height measurements at different levels of the rectum, and 3.) to determine the probability of a two centimeter increase in tumor height after mobilization in low rectal cancers. METHODS: Prospective cross-sectional series including all resectable rectal cancer treated at our hospital from January to December, 2003. Proctoscopy measurements of rectal tumor height after induction of anesthesia were compared to measurements done after complete rectal mobilization. Logistic curve fitting was used to calculate the probability of a two centimeter increase in tumor height for low rectal cancers after complete mobilization.RESULTS: In the 12-month period, 37 patients with adenocarcinoma of the rectum were seen. Ages of patients ranged from 26 to 86, with mean age of 57.8 years. Thirty-three patients had resectable rectal cancer. Tumor height ranged from zero to 11 cm, with mean height of 5.7 cm. After complete mobilization, tumor height increased in 50 percent of upper rectal cancers, 92 percent of mid-rectal cancers, and 32 percent of low rectal cancers. Logistic curve fitting showed probability of a two-centimeter increase in tumor height was 52 percent at seven centimeters, 40 percent at six centimeters, 28 percent at five centimeters, and 19 percent at four centimeters. DISCUSSION: The decision to perform APR for low rectal cancers must not be based solely in pre-operative tumor height measurements since pre-operative measurements of rectal tumor height can increase when the rectum is completely mobilized.