Does the body mass index impact lymph node yield for colorectal cancer resection, and does operative approach influence this: a review of bi-national colorectal cancer audit database

Breaking Myths: Comparable Outcomes in Lymph Node Analysis Across Surgical Methods

BACKGROUND/OBJECTIVES

Colorectal cancer is the third most common cancer worldwide, making lymph node recovery critical for treatment decisions and prognosis. The relationship between body mass index (BMI) and the number of lymph nodes retrieved during laparoscopic and open surgeries remains controversial. This study aimed to evaluate whether surgical approach and BMI influence lymph node retrieval in colon cancer surgeries.

METHODS

A retrospective analysis was conducted on 560 patients who underwent colon cancer surgery at a single institution between 2018 and 2023. The average number of lymph nodes retrieved during laparoscopic and open procedures was compared. Distribution analysis using violin plots was performed to assess the pattern of lymph node yield between surgical approaches. Additionally, the impact of BMI on lymph node recovery was assessed. All surgeries were performed by a standardized surgical team using consistent fat clearance techniques.

RESULTS

The mean number of lymph nodes retrieved was 15.89 ± 0.84 for laparoscopic surgeries and 15.98 ± 0.50 for open surgeries, with no statistically significant difference (p = 0.9166). The violin plot analysis confirmed overlapping distributions between the two surgical approaches, with no significant difference (p = 0.6270). BMI also showed no significant effect on the number of lymph nodes removed during surgery. The consistency in outcomes was attributed to standardized surgical practices across all cases.

CONCLUSIONS

Laparoscopic and open surgical approaches yield comparable lymph node recovery in colon cancer surgeries, both in terms of mean values and overall distribution patterns, regardless of patient BMI. These findings emphasize the importance of standardized surgical techniques in ensuring reliable outcomes and suggest that both approaches are equally effective in meeting oncological standards for lymph node retrieval.

Comparison of laparoscopic and open surgery for colorectal malignancy in obese patients: a propensity score-weighted cohort study

BACKGROUND

Insufficient evidence exists to ascertain the long-term prognosis in patients with obesity undergoing laparoscopic surgery versus open surgery for colorectal cancer.

METHODS

Employing an institutional database from 2009 to 2019, we assessed individuals with a BMI of greater than or equal to 30 kg/m 2 who underwent surgery for primary stage I-III colorectal adenocarcinoma. The authors used propensity score-weighted analysis to compare short-term and oncologic outcomes between laparoscopic and open surgical approaches.

RESULTS

This study enrolled 473 patients (open vs. laparoscopic surgery: 220 vs. 253; median follow-up period, 60 months). The laparoscopy group showed a significantly longer operative time (252 vs. 212 min), a higher anastomotic-leakage rate (5.14% vs. 0.91%), and a greater proportion of Clavien-Dindo class greater than III complications (5.93% vs. 1.82%). The open group showed a higher wound infection rate (7.27% vs. 3.16%) and a higher readmission rate (6.36% vs. 2.37%). After propensity score weighting, laparoscopy was inferior to open surgery in terms of long-term overall survival (hazard ratio: 1.43), disease-free survival (1.39), and recurrence rate (21.1% vs. 14.5%). In the subgroup analysis, female patients, older individuals, stage III patients, patients with rectal cancer, and those who underwent surgery after 2014 showed inferior long-term outcomes after laparoscopy.

CONCLUSIONS

Laparoscopic colorectal cancer surgery for patients with obesity requires significant caution. Despite good short-term outcomes, this procedure is associated with hidden risks and poor long-term prognoses. In female patients, older individuals, stage III patients, patients with rectal cancer, and those treated in the late surgery era subgroups, caution is advised when performing laparoscopic surgery.

Nodal Yield in Level II-IV Neck Dissections in Head and Neck Squamous Cell Carcinoma

OBJECTIVES

The main objective of this study is to analyze factors associated with nodal yield in level II-IV selective neck dissections (NDs) and the secondary objective is to assess its impact on overall and disease-free survival.

METHODS

Observational retrospective study including adult patients submitted to level II-IV ND from January 2015 to December 2021 in the otorhinolaryngology department of a tertiary hospital center.

RESULTS

A total of 44 patients and 78 level II-IV NDs (34 bilateral and 10 unilateral) were included. The median age at diagnosis was 60 (22-74) years, and 93.2% of the patients were male. A lower nodal yield was significantly associated with previous radiotherapy (p = 0.042) and extranodal invasion (p < 0.001) and was non-significantly associated with older age (p = 0.065). Furthermore, on a Cox analysis adjusted to the cN status and age, the nodal yield was not associated with five-year disease-free survival (HR = 0.986; 95% CI = 0.922-1.054; p = 0.681) nor with five-year overall survival (HR = 1.006; 95% CI = 0.925-1.095; p = 0.888).

CONCLUSION

A reduced nodal yield in level II-IV NDs was significantly associated with previous radiotherapy and extranodal extension and non-significantly associated with age. There was no association between the nodal yield and five-year overall survival or disease-free survival.

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

OBJECTIVE

Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.

DESIGN

Systematic review and meta-analysis of primary studies.

DATA SOURCES

PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.

DATA EXTRACTION AND SYNTHESIS

OR with 95% conference intervals was extracted and pooled.

RESULTS

A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph-vascular invasion were not significantly associated with the lymph node yield.

CONCLUSIONS

The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.