Impact of Lymph Node Retrieval and Pathological Ultra-Staging on the Prognosis of Stage II Colon Cancer

Background and Objectives: A minimum number of lymph nodes must be assessed for accurate diagnosis of stage II colon cancer. We assessed number of lymph nodes retrieved, pathological ultra-staging, and outcome in stage II colon cancer. Materials and Methods: Consecutively treated patients with stage II colon cancer were identified. Baseline and outcome data were collected. Retrospective ultra-staging using lymphovascular invasion (LVI) and nodal micrometastases was performed. Patients were divided into two groups: group I had ≤6 nodes and group II had >6 nodes retrieved. Survival was analyzed. Results: One hundred and fifteen patients were included in the study. The 5 year overall survival was worse in group I versus II (P = 0.03). LVI and micrometastases were identified but neither predicted survival. Disease failure in group I was due to distant metastases rather than local recurrence. Conclusions: Inadequate retrieval and assessment of lymph nodes is associated with worse outcome in stage II colon cancer patients. Recurrence patterns support the hypothesis that disease recurrence occurred due to inaccurate staging. In this small study, LVI or nodal micrometastases did not predict survival. Maximal attention should be paid to the total number of lymph nodes retrieved before embarking on potentially more resource intensive staging methods.