What factors affect lymph node yield in surgery for rectal cancer?

OBJECTIVE: The detection of lymph node metastases is of vital importance in patients undergoing excisional surgery for rectal cancer as it provides important prognostic information and facilitates decision-making with regards to adjuvant therapy. It has been suggested that patients in whom only a small number of nodes are present in the excised specimen have a worse prognosis, presumably due to inadequate lymphadenectomy and consequent understaging of the disease. The aim of this study was to determine which factors affect the yield of lymph nodes. METHODS: This was a retrospective study of patients who had undergone a resection for histologically proven adenocarcinoma of the rectum. The total number of lymph nodes identified in the excised specimen was recorded in each case. A multivariate analysis was performed to ascertain whether this number was significantly influenced by any of several variables. RESULTS: A total of 167 patients were studied (M:F ratio 107 : 60, median age 70 years). The median number of lymph nodes contained within the resected specimen was 16 (interquartile range 10-21). On univariate analysis a significantly higher yield of lymph nodes was obtained with tumours in the middle third of the rectum (P=0.007), larger tumours (P < 0.001), more locally advanced tumours according to both pT staging (P=0.001) and Dukes' staging (P=0.020), an increased number of involved nodes (P=0.003) and examination by a specialist histopathologist (P=0.003). On multivariate analysis the only significant variables were tumour size (P=0.021), number of positive nodes (P=0.007) and histopathologist (P=0.021). CONCLUSIONS: The number of lymph nodes identified within the excised specimen in patients undergoing resection of a rectal cancer positively correlates with the size of the tumour and is also dependent on the examining histopathologist. In addition, in node-positive patients the number of involved nodes increases with increasing lymph node yield.

The two week referral for colorectal cancer: a retrospective analysis.

OBJECTIVE: The two-week referral (TWR) system was introduced in July 2000 to address the delays in referral, diagnosis and treatment of colorectal cancer (CRC) and lessen the associated psychological morbidity of prolonged waiting. General practitioners complete a proforma outlining 'high-risk' criteria for CRC to ensure an urgent referral within 14 days. The aim of the study was to analyse the TWR process and the proforma criteria. PATIENTS AND METHODS: One hundred and forty-nine two-week referral proforma were retrospectively reviewed between January and August 2001. The waiting times and proforma data, together with investigations performed and diagnoses made were gathered for 144 patients. Three did not attend clinic and two sets of notes were missing. RESULTS: Ninety-six percent of patients (n = 144) were two week compliant and 14 CRC (10%) were diagnosed. The most common referral symptom was a recent change in bowel habit (36.6%) but specificity for all criteria was low. The highest diagnostic yield was a palpable abdominal or rectal mass where 16.7% had CRC and iron deficiency anaemia had high sensitivity (90%) for surgical pathology. Per rectum examination and haemoglobin analysis by general practitioners was infrequently performed. DISCUSSION: Our study has shown that CRC is difficult to diagnose by history and examination alone with a 10% detection rate. CRC incidence in TWR may be improved by primary care through routine rectal examinations, increased detection of iron deficiency anaemia and public education to reduce presentation via other referral routes. Further studies are needed to address these issues.

Comparison of service delivery models influencing teachers' use of assistive technology for students with severe disabilities.

Since the 70s and 80s the use of assistive technology in the classroom setting for individuals with severe disabilities has emerged. Assistive technology has provided a new set of tools which allow students to achieve a greater level of independence. Literature review has indicated the need for additional training of related service and classroom personnel in the use of this technology. Training would promote confidence levels in assistive technology application, which may result in increased daily use within the educational domains. The purpose of this research study was to investigate the perceived effectiveness of consultation versus direct service delivery models that influence special educators' and paraprofessionals' use Of assistive technology with students who have severe disabilities. Thirty special educators and sixteen paraprofessionals completed a questionnaire regarding their use of assistive technology with their students and the service delivery model they perceived to be most effective. The results indicated no significant difference between teachers' and paraprofessionals' perceived effectiveness of service delivery models. However, descriptive data did suggest that teachers were utilizing and benefiting from collaborative consultation services when training students with severe disabilities. Limitations to the study and recommendation for further research are also discussed.