Lymph node staging in colorectal cancer: Revisiting the benchmark of at least 12 lymph nodes in R0 resection

摘要

Since the development of Dukes' classification system for colorectal carcinoma in the 1930s by English pathologist Cuthbert Dukes,1 which emphasized the importance of lymph node involvement, the status of lymph nodes in a colorectal cancer resection specimen has remained the most powerful indicator for prognostication and management. The most important components in lymph node staging include the presence or absence of metastasis in lymph nodes and the total number of lymph nodes examined. The assessment of both components, however, can be influenced by many factors, and how best to carry out the assessment has been an evolving topic. This review aims at analyzing the various factors that can potentially influence lymph node assessment, and how such influences can impact the clinical application of the current benchmark requirement of at least 12 lymph nodes for a colonic or rectal cancer resection.