Non-surgical factors influencing lymph node yield in colon cancer

There are numerous factors which can affect the lymph node(LN) yield in colon cancer specimens.The aim of this paper was to identify both modifiable and nonmodifiable factors that have been demonstrated toaffect colonic resection specimen LN yield and to summarise the pertinent literature on these topics.A literature review of Pub Med was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens.The terms used for the search were:LN,lymphadenectomy,LN yield,LN harvest,LN number,colon cancer and colorectal cancer.Both nonmodifiable and modifiable factors were identified.The review identified fifteen non-surgical factors:(13 nonmodifiable,2 modifiable) which may influence LN yield.LN yield is frequently reduced in older,obese patients and those with male sex and increased in patients with right sided,large,and poorly differentiated tumours.Patient ethnicity and lower socioeconomic class may negatively influence LN yield.Pre-operative tumour tattooing appears to increase LN yield.There are many factors that potentially influence the LN yield,although the strength of the association between the two varies greatly.Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.

Outcome following incomplete surgical cytoreduction combined with intraperitoneal chemotherapy for colorectal peritoneal metastases

Cytoreductive surgery combined with intraperitoneal chemotherapy can improve survival in appropriately selected patients with colorectal peritoneal metastases. Outcomes are best in those patients in whom a complete cytoreduction can be achieved. Unresectabledisease is however encountered in approximately one-quarter of patients at laparotomy. The merits, or otherwise, of proceeding with an incomplete cytoreduction in this setting are unclear. We performed a review of published outcomes following incomplete cytoreduction for colorectal peritoneal metastases. Using the electronic databases, Pub Med and MEDLINE, a systematic search of available literature published during the period January 1997 to September 2014 was conducted. Following application of exclusion criteria, 19 papers were identified and included in this review. These comprised fifteen case series, 3 case control studies and one randomised control trial. In the nineteen studies included in this review, 2790 patients underwent cytoreductive surgery with or without intraperitoneal chemotherapy for peritoneal metastases of colorectal origin. Of these, 1732(62%) underwent a complete cytoreduction while 986(35%) patients underwent an incomplete cytoreduction. Median survival in the complete cytoreduction group ranged from 11 to 62 mo while survival in the latter group ranged from 2.4 to 32 mo. Of the 986 patients with an incomplete cytoreduction, 331 patients received intraperitoneal chemotherapy and survival in this cohort ranged from 4.5 to 32 mo. An incomplete cytoreduction, with or without intraperitoneal chemotherapy, does not appear to confer a survival benefit. The limited available data points to a palliative benefit in a subset of patients. In the absence of high quality data, the decision as to whether or not to proceed with surgery should be made on an individual patient basis.