Lymph node harvest in colon cancer specimens depends on tumour factors, patients and doctors, but foremost on specimen handling

There are good indications that the number of lymph nodes found in the specimen after resections for colon cancer somehow has a bearing on prognosis. Many factors have been reported in the literature to influence lymph node retrieval. We wanted to assess these closer with special focus on the pathology handling process in our own practice. A range of international literature was reviewed to study what has been found to influence lymph node harvest. A questionnaire was sent to 13 renowned national and international institutions to explore their handling of the colon cancer specimens to obtain a histological diagnosis. A retrospective, hospital audit was undertaken to examine if the number of lymph nodes and staging after examinations of the specimens varied between individual pathologists. In the literature, tumour and patient characteristics, as well as the surgeon and the pathologist, are found to be influential, but it is difficult to ascertain which ones are truly essential. Fat solvents were found by several to increase the lymph node yield, although some also opposed this finding. Our questionnaire showed some variations in the routines of each Department. A junior pathologist was more likely to inspect the specimen first hand and not more than half employed specific lymph node detection strategies while three of 13 did not seek a minimum number of lymph nodes. Still every department had implemented a standard procedure for such examinations. The internal audit showed without doubt that the devotion of the pathologist secured significantly more lymph nodes from the specimen and this may also have detected more stage III cancers. Several tumour and individual patient characteristics, surgical approach and specimen handling may influence lymph node yield and theoretically, TNM staging. Our investigation specifically suggests that tissue handling by pathologists may be a prominent factor in lymph node harvest from colon cancer specimens.