T1 colon cancer in the era of screening: risk factors and treatment

F. Bianco, S. De Franciscis, A. Belli, Armando Falato, R. Fusco, D. F. Altomare, A. Amato, C. R. Asteria, A. Avallone, Gian Andrea Binda, L. Boccia, Paolo Buzzo, Michele Carvello, C. Coco, P. Delrio, P. Nardi, M. Di Lena, A. Failla, F. Torre, M. TorreM. Lemma, P. Luffarelli, G. Manca, Isacco Maretto, F. Marino, A. Muratore, Adolfo Pascariello, Salvatore Pucciarelli, D. Rega, V. Ripetti, G. Rizzo, Alberto Serventi, A. Spinelli, F. Tatangelo, E. D.L. Urso, G. M. Romano, behalf of the Italian Society of Colo-Rectal Surgery (SICCR) Cancer Group on behalf of the Italian Society of Colo-Rectal Surgery (SICCR) Cancer Group

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The aim of this study was to identify risk factors for lymph node positivity in T1 colon cancer and to carry out a surgical quality assurance audit. Methods: The sample consisted of consecutive patients treated for early-stage colon lesions in 15 colorectal referral centres between 2011 and 2014. The study investigated 38 factors grouped into four categories: demographic information, preoperative data, indications for surgery and post-operative data. A univariate and multivariate logistic regression analysis was performed to analyze the significance of each factor both in terms of lymph node (LN) harvesting and LN metastases. Results: Out of 507 patients enrolled, 394 patients were considered for analysis. Thirty-five (8.91%) patients had positive LN. Statistically significant differences related to total LN harvesting were found in relation to central vessel ligation and segmental resections. Cumulative distribution demonstrated that the rate of positive LN increased starting at 12 LN harvested and reached a plateau at 25 LN. Conclusions: Some factors associated with an increase in detection of positive LN were identified. However, further studies are needed to identify more sensitive markers and avoid surgical overtreatment. There is a need to raise the minimum LN count and to use the LN count as an indicator of surgical quality.

Original languageEnglish
Pages (from-to)139-147
Number of pages9
JournalTechniques in Coloproctology
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

Keywords

  • Early-stage colon cancer
  • Lymph node metastases
  • Quality assurance
  • Screening

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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