Does Laparoscopic Approach Affect the Number of Lymph Nodes Harvest in Colorectal Cancer?
Galal S. El-Gazzaz*, Geisler P. Daniel, Tracy L. Hull
Colorectal surgery, Cleveland Clinic, Cleveland, OH
Purpose: Adequate lymph node (LN) retrieval (>12 LN) is increasingly being considered a surgical quality indicator for colorectal cancer. The purpose of this study is to assess LN yield after laparoscopic colorectal cancer resection compared to the open approach and to analyze changes in harvesting over time in our practice.Methods; From 1996-2007, 431 colorectal cancer patients underwent curative laparoscopic resection. During the study periods of 1996-1997, 2002-2003, and 2006-2007, 243 patients undergoing laparoscopic resection for colorectal cancer were studied. They were matched to 260 control patients undergoing conventional surgery identified from our cancer database and matched by age, operation, gender, date of operation and body mass index. Numbers of examined and involved LNs were compared between the two techniques according to location of tumor and year of surgery. Results; A total of 503 patients (303 male) with a mean age of 66.2+/-12.3 years, and a mean body mass index of 26.7+/-7.3 kg/m2 underwent colorectal cancer resection (243 laparoscopically, 260 open resection) during the study period. The overall average number of LNs retrieved per case was 23.9+/-18.3. There was no statistically significant difference in number of LNs retrieved by laparoscopic versus conventional open surgery (24.1+/- 19.3 laparoscopic vs 23.79+/-17.50 for open p=0.4) There were significant difference between involved LNs retrieved laparoscopically and by open technique (2.04+/- 3.6 vs 1.88+/-4.69 P=0.032). Also, There were significant differences between number of LNs retrieved from right colon, left colon and rectum (28.03+/-14.62, 24.48+/-17.59&19.13+/-15.11) respectively (P<0.001).The year of surgery show significant difference in number of involved LNs in laparoscopic cases only between 1996/1997 and 2006/2007 (P=0.003). Conclusion; Laparoscopic resection of colorectal cancer can achieve similar LN retrieval to the open approach. In this era of new technology and refinement of laparoscopic techniques, LN harvest becomes more optimized.
Variable | Overall No (lap/open) | Laparoscopic | Open | P value | |||
Examined LN | Involved LN | Examined LN | Involved LN | P value Examined LN | p value Involved LN | ||
laparoscopic | 243(48.3%) | ||||||
open | 260(51.7%) | ||||||
Examined LN | 24.1±19.3 | 23.8±17.5 | 0.97 | ||||
Involved LN | 2.0±3.6 | 1.8±4.7 | 0.032 | ||||
Rt Colon | 194 (101/93) | 26.2+/12.4 | 2.1±4.6 | 28.4±15.6 | 1.5±2.7 | 0.2 | 0.04 |
Lt Colon | 161 (82/79) | 25.19±11.9 | 2.2±4 | 23.8±19.7 | 2.3±6.0 | 0.3 | 0.4 |
Rectum | 148(60/88) | 19.0±11.2 | 1.7±4.3 | 19.8±16.1 | 2.1±5.3 | 0.4 | 0.3 |
1996-1997 | 125(61/64) | 25.0±16.0 | 2.2±3.2 | 23.4±16.2 | 1.9±3.6 | 0.23 | 0.29 |
2002-2003 | 127(54/73) | 20.5±16.5 | 2.6±5.5 | 23.8±18.7 | 1.9±4.8 | 0.052 | 0.04 |
2006-2007 | 251(128/123) | 26.4±17.4 | 1.7±4.8 | 23.5±19.8 | 1.9±1.5 | 0.13 | 0.3 |