Annals of Coloproctology

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Original Articles

Colorectal cancer

Evaluation of the utility of a nomogram for predicting lymph node metastasis in T1 colorectal cancer in shared decision-making in clinical practice: a survey-based study: Hyeon Seung Kim, Kyung Su Han, Min Wan Lee, Dae Kyung Sohn, Chang Won Hong, Dong Woon Lee, Kiho You, Sung Chan Park, Byung Chang Kim, Bun Kim, Jae Hwan Oh; Ann Coloproctol. 2025;41(4):303-309. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00318.0045

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Abstract PDF: Purpose
In 2019, we reported a novel nomogram to predict lymph node metastasis (LNM) in T1 colorectal cancer. Herein, we conducted a survey-based study to evaluate the clinical utility of this nomogram in determining the need for additional surgery after endoscopic resection for high-risk T1 colorectal cancer.
Methods
A survey was conducted among 77 members of the Korean Society of Coloproctology and 25 members of the Korean Society of Gastrointestinal Endoscopy. The survey assessed decision-making regarding additional surgery after endoscopic resection for high-risk T1 colorectal cancer according to various predicted LNM rates (3%, 10%, and 27%) and tumor locations (anal verge [AV] 2, 7, and 25 cm). Additionally, participants provided feedback regarding the reliability, usefulness, and potential adoptability of the prediction model in patient counseling.
Results
Of the 2,314 surveys distributed, 102 responses were analyzed. A trend was observed in which tumors located closer to the anus and associated with a lower predicted risk of LNM were less likely to lead respondents to opt for surgery (e.g., AV 2 cm and 3% of predicted LNM risk, 21.6% opt for surgery vs. AV 25 cm and 27% of predicted LNM risk, 98.0% opt for surgery). Additionally, 94.1% of the respondents reported that the prediction model would be helpful in clinical decision-making and patient counseling.
Conclusion
Our findings suggest that the nomogram is an effective and reliable tool for guiding treatment strategies and enhancing consultations in patients with T1 colorectal cancer.

Minimally invasive surgery

A comparative study of the pathological outcomes of robot-assisted versus open surgery for rectal cancer: René Reyes, Csaba Kindler, Kenneth Smedh, Catarina Tiselius; Ann Coloproctol. 2024;40(2):154-160. Published online December 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00332.0047

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Abstract PDF

Purpose
The use of robot-assisted surgery for rectal cancer is increasing, but the pathological outcomes have not been fully clarified. We compared the surgical and pathological outcomes between robot-assisted and open surgery in specimens from patients operated on for rectal cancer.
Methods
All patients who underwent resection for rectal cancer from 2016 to 2018 were included (n=137). Specimens were divided into 3 sections to analyze the pathology of the lymph nodes.
Results
The total specimen lengths were shorter in the robot-assisted group than in the open surgery group (mean±standard deviation: 29.1±8.6 cm vs. 33.8±9.9 cm, P=0.004) because of a shorter proximal resection margin (21.7±8.7 cm vs. 26.4±10.6 cm, P=0.006). The number of recruited lymph nodes (35.8±21.8 vs. 39.6±16.5, P=0.604) and arterial vessel length (8.84±2.6 cm vs. 8.78±2.4 cm, P=0.891) did not differ significantly between the 2 surgical approaches. Lymph node metastases were found in 33 of 137 samples (24.1%), but the numbers did not differ significantly between the procedures. Among these 33 cases, metastatic lymph nodes were located in the mesorectum (75.8%), in the sigmoid colon mesentery (33.3%), and at the arterial ligation site of the inferior mesenteric artery (12.1%). The circumferential resection margin and the proportion of complete mesorectal fascia were comparable between the groups.
Conclusion
There were no significant differences between the 2 surgical approaches regarding arterial vessel length, recruitment of lymph node metastases, and resection margins.

Citations

Citations to this article as recorded by

Robotic Surgery for Rectal Cancer Treatment: Clinical Outcomes and Quality of Life. Comparison of Surgical Methods
Raminta Akelaitytė, Justas Žilinskas
Lietuvos chirurgija.2025; 24(3): 184. CrossRef
Can robotic surgery lead the way in the treatment of rectal cancer?
Jeonghee Han
Annals of Coloproctology.2024; 40(2): 87. CrossRef
Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis
E. Barzola, L. Cornejo, N. Gómez, A. Pigem, D. Julià, N. Ortega, O. Delisau, K. A. Bobb, R. Farrés, P. Planellas
Journal of Robotic Surgery.2023; 17(6): 3013. CrossRef

Colorecal cancer

Prognostic significance of lymph node yield on oncologic outcomes according to tumor response after preoperative chemoradiotherapy in rectal cancer patients: Hyo Seon Ryu, In Ja Park, Bo Kyung Ahn, Min Young Park, Min Sung Kim, Young Il Kim, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(5):410-420. Published online April 28, 2022; DOI: https://doi.org/10.3393/ac.2022.00143.0020

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Graphical Abstract Abstract PDF

Purpose
This study aimed to evaluate the predictive value of lymph node yield (LNY) for survival outcomes according to tumor response after preoperative chemoradiotherapy (PCRT) in patients with rectal cancer.
Methods
This study was a retrospective study conducted in a tertiary center. A total of 1,240 patients with clinical stage II or III rectal cancer who underwent curative resection after PCRT between 2007 and 2016 were included. Patients were categorized into the good response group (tumor regression grade [TRG], 0–1) or poor response group (TRG, 2–3). Propensity score matching was performed for age, sex, and pathologic stage between LNY of ≥12 and LNY of <12 within tumor response group. The primary outcome was 5-year disease-free survival (DFS) and overall survival (OS).
Results
LNY and positive lymph nodes were inversely correlated with TRG. In good responders, 5-year DFS and 5-year OS of patients with LNY of <12 were better than those with LNY of ≥12, but there was no statistical significance. In poor responders, the LNY of <12 group had worse survival outcomes than the LNY of ≥12 group, but there was also no statistical significance. LNY of ≥12 was not associated with DFS and OS in multivariate analysis.
Conclusion
LNY of <12 showed contrasting outcomes between the good and poor responders in 5-year DFS and OS. LNY of 12 may not imply adequate oncologic surgery or proper staging in rectal cancer patients treated by PCRT. Furthermore, a decrease in LNY should be comprehended differently according to tumor response.

Citations

Citations to this article as recorded by

Breaking Myths: Comparable Outcomes in Lymph Node Analysis Across Surgical Methods
Salvatore Pezzino, Tonia Luca, Mariacarla Castorina, Giulia Fuccio Sanzà, Gaetano Magro, Stefano Puleo, Ornella Coco, Sergio Castorina
Cancers.2025; 17(8): 1312. CrossRef
A predictive nomogram for assessing the likelihood of retrieving 12 lymph nodes after rectal cancer surgery: a single-center study
Jian Ma, Runyang Hao, Shuai Jiao, Qingmin Chen, Baohong Yang, Xu Guan, Jiale Li, Xinxuan Zhao, Yu Huo, Qingxia Xu, Haiyi Liu, Wen Su, Xishan Wang
Frontiers in Oncology.2025;[Epub] CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Artificial Intelligence-Driven Volumetric Analysis of Muscle Mass as a Predictor of Tumor Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer
Minsung Kim, Sang Min Lee, Il Tae Son, Jaewoong Kang, Gyoung Tae Noh, Bo Young Oh
Journal of Clinical Medicine.2024; 13(23): 7018. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef

Preoperative endoscopic tattoo marking improves lymph node retrieval in laparoscopic rectal resection: a retrospective cohort study: Kouki Imaoka, Takuya Yano, Masanori Yoshimitsu, Sotaro Fukuhara, Ko Oshita, Kanyu Nakano, Masaki Kunihiro, Hitoshi Idani, Masazumi Okajima; Ann Coloproctol. 2023;39(2):115-122. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00458.0065

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Graphical Abstract Abstract PDF

Purpose
Harvesting at least 12 lymph nodes (LNs) is recommended for adequate tumor staging in colon surgery. Although preoperative endoscopic tattooing has been used for primary localization of tumors, its impact on LN retrieval in colorectal surgery remains controversial. We aimed to investigate the relationship between preoperative tattooing and LN retrieval after laparoscopic rectal resection.
Methods
We reviewed the records of 92 patients with rectal cancer who underwent laparoscopic resection from January 1, 2018 to December 31, 2019. Patients were categorized into 2 groups according to whether preoperative endoscopic tattooing was performed. The rate of adequate LN retrieval (≥12) was compared.
Results
The tattooed and non-tattooed groups comprised 49 and 43 patients, respectively. In the tattooed and non-tattooed groups, the rates of adequate LN retrieval were 75.5% and 55.8%, respectively (P=0.046). Univariate analysis revealed that female sex, tattooing, LN metastasis status, pathological pathological stage (p-stage), and LN dissection were predictive factors for adequate LN retrieval. In the multivariate analysis, female sex (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.15–9.73; P=0.027), tattooing (OR, 2.87; 95% CI, 1.03–7.94; P=0.043), and p-stage (OR, 3.34; 95% CI, 1.04–10.75; P=0.043) were independent predictive factors for adequate LN retrieval after surgery.
Conclusion
This study revealed that preoperative endoscopic tattooing was statistically significantly associated with adequate LN retrieval in patients with rectal cancer who underwent laparoscopic rectal resection. Preoperative endoscopic tattooing should be considered to improve disease assessment and avoid stage migration.

Citations

Citations to this article as recorded by

Tattooing Rectal Cancer: Necessary Mark or Unnecessary Ink? Perspective From a Regional Australian Unit
Ju Yong Cheong, Shihaz Hussain
ANZ Journal of Surgery.2026;[Epub] CrossRef
Current roles of colonoscopy in minimally invasive colorectal surgery: Preoperative guidance, intraoperative colonoscopy, and combined endoscopic-laparoscopic surgery
Yuuri Hatsuzawa, Shingo Tsujinaka, Tomoya Miura, Yoh Kitamura, Atsushi Mitamura, Kentaro Sawada, Makoto Hikage, Toru Nakano, Chikashi Shibata
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
To what extent does endoscopic tattooing marking boost lymph node retrieval?
Won Beom Jung
Annals of Coloproctology.2023; 39(2): 95. CrossRef
The effect of preoperative endoscopic tattooing on lymph node retrieval in colorectal cancer: a systematic review and meta-analysis
Mohamad Nawras, Karan Chawla, Armelle DeRiso, Christina Dubchuk, Azizullah Beran, Muhammad Aziz, Stephanie M. Pannell
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis
Qianqian Liu, Min Huang, Jing Yang, Mengyuan Jiang, Ziru Zhao, Haitong Zhao, Tingting He, Yuping Bai, Rui Zhang, Min Zhang
BMJ Open.2023; 13(12): e072244. CrossRef

Malignant disease,Prognosis and adjuvant therapy

Identification of Risk Factors Associated With Stage III Disease in Nonmetastatic Colon Cancer: Results From a Prospective National Cohort Study: Jakob Lykke, Ole Roikjaer, Per Jess, Jacob Rosenberg, On behalf of the Danish Colorectal Cancer Group; Ann Coloproctol. 2020;36(5):316-322. Published online February 18, 2020; DOI: https://doi.org/10.3393/ac.2019.03.03

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Abstract PDF

Purpose
This study aimed to identify possible patient- and tumor-related factors associated with risk of TNM stage III disease in nonmetastatic colon cancer.
Methods
The associations between stage III disease and age, sex, lymph node yield, pathological tumor (pT) stage, tumor subsite, type of surgery, and priority of surgery were assessed in a nationwide cohort of 13,766 patients treated with curative resection of colon cancer. Each level of age, lymph node yield, and pT stage was compared to the preceding level.
Results
Age, lymph node yield, pT stage, tumor subsite, and priority of surgery were associated with stage III disease. Odds ratios (95% confidence interval [CI]) were as follows: age < 65/65–75 years: 1.28 (95% CI, 1.15–1.43) and 65–75/ > 75 years: 1.22 (95% CI, 1.13–1.32); lymph node yield 0–5/6–11: 0.60 (95% CI, 0.50–0.72), lymph node yield 6–11/12–17: 0.84 (95% CI, 0.76–0.93), and lymph node yield 12–17/ ≥ 18: 0.97 (95% CI, 0.89–1.05); pT1/pT2: 0.74 (95% CI, 0.57–0.95), pT2/pT3: 0.35 (95% CI, 0.30–0.40), and pT3/pT4: 0.49 (95% CI, 0.47–0.54). Only tumors of the transverse colon were independently associated with lower risk of stage III disease than tumors in the sigmoid colon (sigmoid colon: 1, transverse colon: 0.84 [95% CI, 0.73–0.96]; elective surgery: 1, acute surgery: 1.43 [95% CI, 1.29–1.60]).
Conclusion
In this study, stage III disease in colon cancer was significantly associated with age, lymph node yield, pT stage, tumor subsite, and priority of surgery but was not associated with right-sided location compared with stage I and II cancers.

Citations

Citations to this article as recorded by

Optimized workup of lymph nodes in regard to UICC classification of colorectal carcinoma
Moritz Rust, Nabih Farkouh, Piet Beusker, Ali Eissing‐Al‐Mukahal, Clara Böker, Julian Mall, Ludwig Wilkens
Histopathology.2026;[Epub] CrossRef
Association of the pathomics-collagen signature with lymph node metastasis in colorectal cancer: a retrospective multicenter study
Wei Jiang, Huaiming Wang, Xiaoyu Dong, Yandong Zhao, Chenyan Long, Dexin Chen, Botao Yan, Jiaxin Cheng, Zexi Lin, Shuangmu Zhuo, Hui Wang, Jun Yan
Journal of Translational Medicine.2024;[Epub] CrossRef
Can clinicopathologic high-risk features in T3N0 colon cancer be reliable prognostic factors?
Hyun Gu Lee, Young IL Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2023; 104(2): 109. CrossRef
Deep learning-based pathology signature could reveal lymph node status and act as a novel prognostic marker across multiple cancer types
Siteng Chen, Jinxi Xiang, Xiyue Wang, Jun Zhang, Sen Yang, Wei Yang, Junhua Zheng, Xiao Han
British Journal of Cancer.2023; 129(1): 46. CrossRef
Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef
Deep learning can predict lymph node status directly from histology in colorectal cancer
Lennard Kiehl, Sara Kuntz, Julia Höhn, Tanja Jutzi, Eva Krieghoff-Henning, Jakob N. Kather, Tim Holland-Letz, Annette Kopp-Schneider, Jenny Chang-Claude, Alexander Brobeil, Christof von Kalle, Stefan Fröhling, Elizabeth Alwers, Hermann Brenner, Michael Ho
European Journal of Cancer.2021; 157: 464. CrossRef

Review

Lateral Lymph Node Dissection With the Focus on Indications, Functional Outcomes, and Minimally Invasive Surgery: Min Jung Kim, Jae Hwan Oh; Ann Coloproctol. 2018;34(5):229-233. Published online October 31, 2018; DOI: https://doi.org/10.3393/ac.2018.10.26

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Abstract PDF

The lateral lymph node dissection (LLND) is still a subject of great debate as to the appropriate treatment for patients with mid to low advanced rectal cancer. The guidelines of the Japanese Society for Cancer of the Colon and Rectum recommend a LLND for patients with T3/4 rectal cancer below the peritoneal reflection. However, in most Western countries, a routine LLND is not recommended unless a node or nodes are clinically suspicious for metastasis. Even after preoperative chemoradiotherapy (CRT), an 8% to 12% lateral pelvic recurrence was noted. The size of the lateral lymph node and responsiveness to preoperative CRT should be the main factors for selecting appropriate patients to undergo a LLND. In addition, from the recent literature, a laparoscopic LLND is safe and oncologically feasible and might have some advantages in short-term outcomes.

Citations

Citations to this article as recorded by

Totally Extraperitoneal Approach for Recurrent Lateral Pelvic Lymph Nodes After Rectal Cancer Surgery
Tae-Gyun Lee, Hong-Min Ahn, Hye-Rim Shin, Mi Jeong Choi, Min Hyeong Jo, Heung-Kwon Oh, Duck-Woo Kim, Sung-Bum Kang
Diseases of the Colon & Rectum.2024; 67(6): e360. CrossRef
Laparoscopic Extraperitoneal Approach for Lateral Pelvic Node Dissection in Rectal Cancer: Techniques and Short-Term Outcomes
Ji-Seon Kim, Jin Kim, Se-Jin Baek, Hyunmi Park, Jung-Myun Kwak, Seon-Hahn Kim
Surgical Innovation.2023; 30(1): 13. CrossRef
Lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation: can it be a powerful supplement tool for predicting the status of lateral pelvic lymph nodes in advanced lower rectal cancer
Hao Su, Zheng Xu, Mandula Bao, Shou Luo, Jianwei Liang, Wei Pei, Xu Guan, Zheng Liu, Zheng Jiang, Mingguang Zhang, Zhixun Zhao, Weisen Jin, Haitao Zhou
Surgical Endoscopy.2023; 37(5): 4088. CrossRef
Anatomical Validation of Internal Iliac Vessels Assessed by Three-dimensional Angiographic Analysis
Yuya Takenaka, Naohito Beppu, Masaki Otani, Kazuma Ito, Ayako Imada, Takaaki Matsubara, Jihyung Song, Kei Kimura, Kozo Kataoka, Motoi Uchino, Hiroki Ikeuchi, Masataka Ikeda
Journal of the Anus, Rectum and Colon.2023; 7(3): 186. CrossRef
Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green
Zavier Yongxuan Lim, Swetha Mohan, Sunder Balasubramaniam, Saleem Ahmed, Caroline Ching Hsia Siew, Vishal G Shelat
World Journal of Gastrointestinal Surgery.2023; 15(9): 1841. CrossRef
Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations
Tania C. Sluckin, Alice M. Couwenberg, Doenja M.J. Lambregts, Sanne-Marije J.A. Hazen, Karin Horsthuis, Philip Meijnen, Regina G.H. Beets-Tan, Pieter J. Tanis, Corrie A.M. Marijnen, Miranda Kusters
Clinical Colorectal Cancer.2022; 21(2): 80. CrossRef
Establishment and validation of a nomogram for predicting potential lateral pelvic lymph node metastasis in low rectal cancer
Atsuhiko Sumii, Koya Hida, Yoshiharu Sakai, Nobuaki Hoshino, Daisuke Nishizaki, Tomonori Akagi, Meiki Fukuda, Tomohiro Yamaguchi, Ichiro Takemasa, Takuya Tokunaga, Jun Watanabe, Masahiko Watanabe
International Journal of Clinical Oncology.2022; 27(7): 1173. CrossRef
Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer
Tania C. Sluckin, Sanne-Marije J. A. Hazen, Karin Horsthuis, Doenja M. J. Lambregts, Regina G. H. Beets-Tan, Pieter J. Tanis, Miranda Kusters
European Radiology.2022; 33(1): 483. CrossRef
Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer
Katsuji Tokuhara, Hidehiko Hishikawa, Terufumi Yoshida, Yosuke Ueyama, Kazuhiko Yoshioka, Mitsugu Sekimoto
Surgical Endoscopy.2021; 35(4): 1572. CrossRef
Effect of lateral lymph node dissection on the quality of life and genitourinary function after neoadjuvant chemoradiotherapy for rectal cancer
Ryun Kyong Ha, Boram Park, Sung Chan Park, Hee Jin Chang, Jae Hwan Oh
Annals of Surgical Treatment and Research.2021; 100(2): 109. CrossRef
Does adding lateral pelvic lymph node dissection to neoadjuvant chemotherapy improve outcomes in low rectal cancer?
Brendan Zhen Yang Law, Zeneera Yusuf, Yu En Ng, Emad H. Aly
International Journal of Colorectal Disease.2020; 35(8): 1387. CrossRef
Lateral pelvic lymph node dissection in the management of locally advanced low rectal cancer: Summary of the current evidence
Mootaz Elhusseini, Emad H. Aly
Surgical Oncology.2020; 35: 418. CrossRef
Does lateral lymph node dissection for low rectal cancer improve overall survival? Protocol for a systematic review and meta-analysis
Jeremy Meyer, Niki Christou, Christophe Combescure, Nicolas Buchs, Frédéric Ris
International Journal of Surgery Protocols.2019; 17: 1. CrossRef

Original Articles

Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer: Wafi Attaallah, Omer Gunal, Manuk Manukyan, Gulden Ozden, Cumhur Yegen; Ann Coloproctol. 2013;29(3):100-105. Published online June 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.3.100

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Abstract PDF

Purpose

Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer.

Methods

A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival.

Results

According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS.

Conclusion

This study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.

Citations

Citations to this article as recorded by

Impact of Metastatic Lymph Node Ratio on Survival and Prognosis in Rectal Carcinoma: A Retrospective Cohort Study
Bahadır Kartal, Mehmet Berksun Tutan
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Progress in the diagnosis of lymph node metastasis in rectal cancer: a review
Wei Peng, Huimin Qiao, Linfeng Mo, You Guo
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The Role of Nonmetastatic Lymph Nodes in the Survival of Colorectal Cancer: A Systematic Review
Alexander J. Pennings, Brecht A. van der Velden, Maximilian Kloft, Loes F. S. Kooreman, Jos M. P. Kleijnen, Stephanie O. Breukink, Geerard L. Beets, Heike I. Grabsch, Jarno Melenhorst
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Value of intravoxel incoherent motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rectal cancer
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European Journal of Radiology.2022; 146: 110106. CrossRef
Prognostic Factors of Recurrence and Survival in Operated Patients with Colorectal Cancer
Alimohammad Bananzadeh, Ali Daneshvar Jahromi, Amirhossein Emami Meybodi, Seyed Mohammad Kazem Tadayon, Mohammad Rezazadehkermani
Middle East Journal of Digestive Diseases.2022; 14(1): 44. CrossRef
Radiomics Based on T2-Weighted Imaging and Apparent Diffusion Coefficient Images for Preoperative Evaluation of Lymph Node Metastasis in Rectal Cancer Patients
Chunli Li, Jiandong Yin
Frontiers in Oncology.2021;[Epub] CrossRef
Modified Gastric Cancer AJCC Staging with a Classification Based on the Ratio of Regional Lymph Node Involvement: A Population-Based Cohort Study
Zeping Huang, Yutong Chen, Wenjun Zhang, Haipeng Liu, Zixian Wang, Youcheng Zhang
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Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer
Ji Eun Yoon, Soo Young Lee, Han Duk Kwak, Seung Seop Yeom, Chang Hyun Kim, Jae Kyun Joo, Hyeong Rok Kim, Young Jin Kim
Annals of Coloproctology.2019; 35(3): 137. CrossRef
Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives
Hye Jin Kim, Gyu–Seog Choi
Annals of Coloproctology.2019; 35(3): 109. CrossRef
Proposal of a modified American Joint Committee on Cancer staging scheme for resectable pancreatic ductal adenocarcinoma with a lymph node ratio-based N classification
Huan-Jun Li, Yu-Tong Chen, Shu-Qiang Yuan
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A systematic review of the prognostic value of lymph node ratio, number of positive nodes and total nodes examined in pancreatic ductal adenocarcinoma
M Elshaer, G Gravante, M Kosmin, A Riaz, A Al-Bahrani
The Annals of The Royal College of Surgeons of England.2017; 99(2): 101. CrossRef
Preoperative SCC Antigen, CRP Serum Levels, and Lymph Node Density in Oral Squamous Cell Carcinoma
Mohamad Adel, Chung-Kan Tsao, Fu-Chan Wei, Huei-Tzu Chien, Chih-Hsiung Lai, Chun-Ta Liao, Hung-Ming Wang, Kang-Hsing Fan, Chung-Jan Kang, Joseph Tung-Chieh Chang, Shiang-Fu Huang
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Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Gastric Cancer
Wafi Attaallah, Kivilcim Uprak, Omer Gunal, Cumhur Yegen
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Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research
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Impact of the Number of Lymph Nodes Retrieved on Reliability of Nodal Staging of Stage II Colorectal Carcinomas.: Lee, Tae Mu , Choi, Hong Jo , Park, Ki Jae , Kim, Jung Min , Roh, Young Hoon , Roh, Mee Sook; J Korean Soc Coloproctol. 2005;21(3):167-173.

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Abstract PDF: PURPOSE
The variety of outcomes in patients with stage II colorectal carcinomas might be due to understaging caused by an inadequate number of lymph nodes (LNs) being examined. The aim of this study was to determine if any number of examined LNs reflects a reliable node-negative staging for colorectal carcinomas (CRCs).
METHODS
Data on 241 patients (132 males) who underwent potentially curative resections for pT3 and pT4 CRC were reviewed. The patients ranged in age from 21 to 87 (mean: 58.2) years with a median follow-up of 43 (range: 7~96) months. The relationship between the number of LNs harvested and both the 5-year disease-free survival (DFS) and the overall survival (OS) rates were assessed for stage II CRCs.
RESULTS
A median of 15 LNs (range: 3~104) was harvested per tumor specimen, and lymph-node metastases were present in 107 cases (44.4%). The proportion of lymph-node metastases increased as a function of the number of LNs harvested (P=0.0002; 95% confidence interval, 0.3333~0.8138). The number of LNs revealed to be the best number for dividing stage II patients into subgroups with different DFS and OS rates was ten. The 5-year DFS and OS rates of the 48 patients (35.8%) with nine or fewer LNs harvested were 68.6% and 76.8%, respectively, whereas those of the 86 patients (64.2%) with ten or more LNs harvested were 87.2% and 91.9%, respectively (DFS, P=0.0082; OS, P=0.0303). Moreover, there were no statistical differences between the node-negative patients with nine or fewer LNs harvested and the 67 stage III patients with N1 in respect to the DFS (68.6% vs. 56.7%; P= 0.2031) and the OS (76.8% vs. 68.3%; P=0.2772) rates.
CONCLUSIONS
This study suggests that examining a greater number of lymph nodes increases the likelihood of accurate nodal staging and that a minimum of ten LNs per surgical specimen should be harvested and examined to label a pT3 or pT4 CRC as node-negative.

The Relationship of Depth of Penetration and Tumor Size to the Number of.: Hong, Dong Hwan , Kim, Heung Dae , Shin, Jun Ho , Han, Won Kon , Pae, Won Kil; J Korean Soc Coloproctol. 1997;13(3):343-352.

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Abstract PDF: We examined the interrelationships of depth of penetration, tumor size, and the number of positive lymph nodes in Dukes'c colorectal cancer. This report contains a retrospective study of 256 cases of colorectal cancer that underwent treatment from Jan. 1985 to Dec. 1994 at the Department of Surgery, Kangbuk Samsung Hospital. The most of the patients were on the 6th decades and male to female ratio was 1.27 : 1. By modified Astler-Coller classification, there were stage Cl 29 cases(11.3%), C2 227 cases(88.7%). Eighty patients with colon cancer(31.4%) and 176 patients with carcinoma of the rectum(68.6%) were available for analysis. Utilizing cumulative frequency distributions of tumor size, depth of invasion and the number of positive lymph nodes, comparisons were carried out among three factors. The results indicate that there was no correlation between the longest diameter of the tumor and other two factors but the number of positive lymph node was closely related to depth of invasion. In conclusion, the number of positive lymph node and depth of invasion are very important prognostic factor. But tumor size as a single factor does not correlated with prognosis in Dukes' C colorectal cancer.

Is Laparoscopic Procedure Adequate for Colorectal Cancer Surgery?.: Kim, Jae Hwang , Huh, Jin Myeung , Yoon, Sung Su , Kim, Sang Woon , Shim, Min chul , Kwun, Koing Bo; J Korean Soc Coloproctol. 1999;15(5):434-442.

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Abstract PDF: PURPOSE
To evaluate the possibility that laparoscopic procedure could perform surgeries keeping the principle of oncologic surgery.
METHODS
From July 1993 to June 1996, thrity patients undergone laparoscopic assisted colon and rectal resections (LR) for malignant disease at Yeungman university hospital. Margins of resection and lymph nodes (LNs) recovered were compared with those of thirty stage matched open resection cases (OR, n=30) retrospectively. There was no operative mortality in both group. Operative techniques used in LR vs OR were colectomy, 5:6; anterior resection, 6:5; low anterior resection, 11:12 and abdominoperineal resection, 8:7. Parameters were analgesic use, duration of postoperative ileus, operative time, hospital stay, margins of rescetion, lymph node yield (LNs), and recurrence.
RESULTS
Patients who underwent LR had less pain, a shorter period of postoperative ileus and hospital stay than patients who underwent OR. But, the length of operative time was greater for patients undergoing LR. Mean lymph node yield in the laparoscopic group was 16 compared with 18.1 in the open group (P=0.560). Average margins of resection in LR vs OR were 13.9 cm vs 14.1 cm proximally (P=0.823), 3.6 cm vs 5.2 cm distally (P=0.498). In no case did the margins contain tumor. There was no statistical significance in dissected LNs and the length of both resection margins in both groups. Recurrence was similar in both groups.
CONCLUSIONS
In this study, there is no evidence that laparoscopic technique is inadequate in following the cancer surgery principle.

Clinical Analysis of T4 Colorectal Cancer with Adhesion to Adjacent Organs.: Cho, Mun Hyeong , Joo, Jai Kyun , Ryu, Seong Yeob , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2003;19(5):290-298.

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Abstract PDF: PURPOSE
A colorectal cancer (CRC) is defined as T4 when the tumor directly invades other organs or structures and/or perforates the visceral peritoneum. The purpose of this study was to evaluate the results of a surgical approach and to determine the significant prognostic factors for tumor resectability and survival in patients with advanced T4 CRC.
METHODS
A total of 61 patients with T4 CRC with adjacent organ adhesion, who received multivisceral resections at Chonnam University Hospital, Korea, between Jan. 1990 and Dec. 2001, were analyzed retrospectively.
RESULTS
Cancer invasion to contiguous organs was present in 51 (83.6%) of the 61 patients who received a multivisceral resection and was absent in 10 (16.4%). Postoperative rates of complications and death were 22.9% and 4.9%, respectively, in the 61 patients. Lymph-node (LN) metastases were presented in 25 patients (41.0%). The 5-year survival rate (5 YSR) was 22.2% in patients with LN metastases, but was significantly higher (66.7%) in patients without LN metastases. The 5 YSRs for the 61 patients according to the AJCC cancer stage (TNM classification) were as follows: stage II (66.7%), stage III (46.4%), and stage IV (0%).
CONCLUSIONS
T4 CRC without distant metastases requires multivisceral en-bloc resection of any organ or structure to which the primary tumor is adhered. The presence of LN metastases at the time of surgery is one of the significant factors with a poor prognosis in T4 CRC.

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