Factors Determining the Yield of Lymph Nodes in Colorectal Carcinoma: a Cross-sectional Study from a Tertiary Care Hospital, Manipal, Karnataka India

Introduction: Colorectal Cancer (CRC) is one of the leading causes of mortality worldwide. Adequate and appropriate treatment depends on accurate histopathological staging. The current College of American Pathologists (CAP) guidelines emphasise sampling 12 Lymph Nodes (LNs) for adequate staging; however, there are situations where this ‘magic number’ is not achieved. Aim: To determine whether a higher Lymph Node Yield (LNY) is associated with tumour upstaging (N status). Materials and Methods: This cross-sectional study was conducted at Kasturba Medical College, Manipal, Karnataka, India and included total 60 resected cases of CRC diagnosed from June 2018 to May 2019 and staged according to Tumour Node Metastasis (TNM), American Joint Cancer Committee (AJCC) 8th edition. The following parameters were analysed: age, sex, type of surgery, excised specimen length, tumour laterality, tumour size, histological grade, Lymph Node (LN) status, Lymphovascular Invasion (LVI), and stage. Statistical analysis: The Student’s t-test (unpaired t-test) was used to determine the level of significance for different parameters. Chisquare and Fisher’s-exact tests were employed in the analysis of nominal variables. Results: A statistically significant value (p<0.05) was obtained from a total of 60 cases with various parameters, including mean age (M=64 years, F=63 years), an average tumour size of 7 cm in greatest dimension, hemicolectomy as the most commonly performed type of surgery, and an average excised specimen length of 36 cm. Stage III and G1 tumours were the most common types. Conclusion: Despite the fact that numerous authors have expressed opinions on the number of LNs sampled, both surgeons and pathologists can improve outcomes by standardising surgical techniques and dedicating more time to these procedures. Various modifiable and non modifiable factors play a significant role in the sampling of LNs. The primary aim of the study was achieved, as findings indicate a possible chance of tumour upstaging when the LNY exceeds 12. Thus, it is crucial for pathologists to sample an adequate number of LNs for appropriate patient management.