Assessment of lymph node involvement in colorectal cancer
| Autor: | Mark L H Ong, John B Schofield |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Colorectal cancer medicine.medical_treatment General surgery Sentinel lymph node Review Sentinel node medicine.disease Surgery 03 medical and health sciences Dissection 0302 clinical medicine medicine.anatomical_structure 030220 oncology & carcinogenesis Biopsy medicine 030211 gastroenterology & hepatology Lymphadenectomy Lymph business Lymph node |
| Zdroj: | World Journal of Gastrointestinal Surgery. 8:179 |
| ISSN: | 1948-9366 |
| Popis: | Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with node-negative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed. |
| Databáze: | OpenAIRE |
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