Authors: Kristian E Storli Karl Søndenaa Ida R K Bukholm Idunn Nesvik Tore Bru Bjørg Furnes Bjarte Hjelmeland Knut B Iversen Geir E Eide
Publish Date: 2011/05/12
Volume: 26, Issue: 10, Pages: 1299-1307
Abstract
A national surveillance program of colon cancer treatment was introduced in 2007 We examined prognostic factors for colon cancer operated in 2000 with an aim of improving survival in the new program and a special focus on the merit of lymph node yieldOverall 5year survival was 580 and overall hospital mortality was 52 with 45 in elective cases and 125 after urgent surgery In only 411 of the specimens were 12 or more lymph nodes retrieved but this did not affect survival in the combined cohort although one of the hospitals achieved a significantly better result with a harvest of 12 or more lymph nodes In a multivariate analysis old age gender a high lymph node ratio LNR at stage III and tumor–node–metastasis stage were adverse factors for survivalThe operative mortality was high and should be reassessed The lymph node count did not have a significant impact on outcome overall whereas the LNR proved significant for stage III A prospective protocol using overall lymph node yield as a surrogate measure for more radical surgery nevertheless seems warranted to improve the lymph node harvest according to international recommendationsIn recent years the results after surgery for rectal cancer in Norway with a 5year overall survival OS rate of 601 has surpassed that of colon cancer at 575 1 This has been achieved because the surgical technique has been standardized according to total mesorectal excision TME with subsequent dramatic reductions of local recurrences Beginning in 2007 all colon cancers were to be reported separately to the Norwegian National Cancer Registry in an effort to systematically survey and hopefully improve results Nevertheless a national strategy to standardize surgical treatment along the lines of radical surgery has neither been implemented in detail nor been generally accepted 2 3In this respect the number of lymph nodes retrieved may act as a surrogate measure of radical surgery The survival benefit of a large lymph node harvest has been shown in several reports 2 3 4 It has been accepted nationally to offer patients with tumor–node–metastasis TNM stage III below a certain age usually 75 years adjuvant chemotherapy This depends on adequate staging and lymph node sampling It has been decided that a rather arbitrary level of 12 retrieved nodes is enough to obtain adequate surgery and staging Pathologists may be a key factor for optimal lymph node harvest and a conjoined effort between surgeon and pathologist would be ideal to improve results 2 3 4 5 6The aim of the study was to examine after modest radical colon surgery removing mesocolic nodes and focus on lymph node yield what would influence survival and where surgical improvement might be possible using data from a cohort of patients from three large Norwegian teaching hospitalsPatients from a national cohort were operated in 2000 and followup was until December 2007 a mean of 75 years later Three teaching community hospitals Haraldsplass Deaconal Hospital Stavanger University Hospital and Akershus University Hospital contributed patients
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