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LYMPH NODE YIELD IN COLORECTAL CANCER: BEYOND THE “RULE OF 12”

MARIUS ZAMFIR ^1,2, ANDREI-BOGDAN VĂCĂRAȘU ^1,2*, MARA MARDARE ^1,2, NICOLETA- IRINA BONDOC ^1,2, ALINA-IOANA PUȘCAȘU ^2,3, THEODOR ANTONIU ², FLAVIA ULTIMESCU ^1,2 , FLORIN GRAMA ^1,4, LUIZA ȘERBĂNESCU ^1,2, GEANINA PAPUC ², NICULAE IORDACHE ^1,5 , MIRCEA-BOGDAN MĂCIUCEANU-ZĂRNESCU ⁶, TUDOR-ION NĂSTĂSESCU ⁷, DIANA IULIANA STANCIU ⁸, ARIANA HUDIȚĂ ⁸, BIANCA GĂLĂȚEANU ⁸, OCTAV GINGHINĂ ¹,2

1 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
² Department 3 Surgery, “Prof. dr. Al. Trestioreanu” Oncologic Institute of Bucharest, Bucharest, Romania
³ University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Romania
⁴ Department of Surgery, “Colțea” Clinical Hospital, Bucharest, Romania
⁵ Department of Surgery, “Sf. Ioan” Emergency Clinical Hospital, Bucharest, Romania
⁶ Plastic and Reconstructive Surgery Discipline - Bucharest Emergency Clinical Hospital, Department 11, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
⁷ Department of Surgery, Tulcea County Emergency Hospital, Tulcea, Romania
⁸ Faculty of Biology, University of Bucharest, Bucharest, Romania

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Colorectal cancer (CRC) staging depends heavily on lymph node evaluation, especially because the threshold of 12 examined nodes is used as a standard across all treatment guidelines. The yield of lymph node excision varies depending on tumour position, extent of dissection, histopathological examination, and neoadjuvant treatment. We performed a retrospective study of 86 patients who underwent CRC surgery, analysing the total number of lymph nodes, the number of positive nodes (N+), the lymph node ratio (LNR), and the relationship between tumour location and surgical approach. The median yield value was 12 nodes with compliance ≥ 12 in 52.3% and extended harvest ≥ 18 in 31.4%. The number of nodes differed significantly between locations, with the highest values in the right colon (mean 24) and the lowest in the rectum (mean 9). Compliance ≥ 12 was 28.6%. The LNR (mean 0.086) can help to complete the staging when the harvest is suboptimal. In conclusion, we consider that the threshold of 12 nodes remains a useful minimum in clinical practice, but new values tailored to tumour location may improve patient prognosis.