Impact of demographic and clinical-pathomorphological factors on the number of removed lymph nodes in complicated colon cancer

Abstract

   Aim: analysis of the influence of demographic and clinicopathologic factors on the lymph nodes yield in complicated colon cancer.   Materials and methods: The cohort retrospective study included data on 227 patients with complicated colon cancer, including: group 1 — n = 76 cancer of the right colon cohort; group 2 — n = 151 cancer of the left colon cohort. Inclusion criteria: patients aged 18 years and older with colon adenocarcinoma of varying degrees of differentiation complicated by obstructive obstruction or perforation. These patients underwent operations within 24 hours from the moment of admission for the period: September 2016 to December 2022 in the hospitals of the Smolensk. Not included in the study: patients with emergency interventions for obstructive obstruction and perforation complicating the course of rectal cancer, non-epithelial malignant tumors, colon carcinoid, appendix adenocarcinoma; patients with stage IV disease.   Results: The median age at the time of complication was 72 years for right colon cancer and 74 for left colon cancer. Most patients had local tumor status pT3, pT4a and pN+(1b–2b) status in regional lymph nodes. The average tumor size in complicated cancer of the right colon cohort was 55.4 ± 23.5 mm, the left colon cohort — 49.3 ± 18.0 mm. The median number of lymph nodes examined was 11 (5–15) for right colon cancer and 7 (3–15) for left colon cancer. Statistically significant factors that had a substantial impact on the number of removed lymph nodes were: age at the time of diagnosis — up to 70 years, local tumor status pT3 and pT4a, tumor localization in the right half of the colon, the presence of metastases in regional lymph nodes, low differentiation of adenocarcinoma.   Conclusion: The results obtained confirm that the lymph nodes yield is affected by demographic factors (age) and clinical and pathomorphological factors, such as tumor localization, local status and size of the tumor, and the degree of differentiation of adenocarcinoma.