1. T1 colon cancer in the era of screening: risk factors and treatment
- Author
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Bianco, F., De Franciscis, S., Belli, A., Falato, A., Fusco, R., Altomare, D. F., Amato, A., Asteria, C. R., Avallone, A., Binda, G. A., Boccia, L., Buzzo, P., Carvello, M., Coco, Claudio, Delrio, P., De Nardi, P., Di Lena, M., Failla, A., La Torre, F., La Torre, M., Lemma, M., Luffarelli, P., Manca, G., Maretto, I., Marino, F., Muratore, A., Pascariello, A., Pucciarelli, S., Rega, D., Ripetti, V., Rizzo, Gianluca, Serventi, A., Spinelli, A., Tatangelo, F., Urso, E. D. L., Romano, G. M., and on behalf of the Italian Society of Colo-Rectal Surgery (SICCR) Cancer Group, Null
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,Lymphatic metastasis ,Multivariate analysis ,Colorectal cancer ,Settore MED/18 - CHIRURGIA GENERALE ,Medical Overuse ,Audit ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Lymph node ,Early Detection of Cancer ,Aged ,Neoplasm Staging ,Retrospective Studies ,Early-stage colon cancer ,Medical Audit ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Quality assurance ,Colorectal surgery ,Acs nsqip ,Logistic Models ,medicine.anatomical_structure ,Lymph node metastases ,Screening ,Colonic Neoplasms ,Female ,Lymph Node Excision ,Lymph Nodes ,Lymphatic Metastasis ,Multivariate Analysis ,Surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
The aim of this study was to identify risk factors for lymph node positivity in T1 colon cancer and to carry out a surgical quality assurance audit.The sample consisted of consecutive patients treated for early-stage colon lesions in 15 colorectal referral centres between 2011 and 2014. The study investigated 38 factors grouped into four categories: demographic information, preoperative data, indications for surgery and post-operative data. A univariate and multivariate logistic regression analysis was performed to analyze the significance of each factor both in terms of lymph node (LN) harvesting and LN metastases.Out of 507 patients enrolled, 394 patients were considered for analysis. Thirty-five (8.91%) patients had positive LN. Statistically significant differences related to total LN harvesting were found in relation to central vessel ligation and segmental resections. Cumulative distribution demonstrated that the rate of positive LN increased starting at 12 LN harvested and reached a plateau at 25 LN.Some factors associated with an increase in detection of positive LN were identified. However, further studies are needed to identify more sensitive markers and avoid surgical overtreatment. There is a need to raise the minimum LN count and to use the LN count as an indicator of surgical quality.
- Published
- 2017
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