East Montgomery Times

Removing and examining at least 18 lymph nodes during colon cancer surgery may lead to more accurate staging and improved survival rates, according to research presented at the Society of Surgical Oncology 2025 Annual Meeting. The study by Fox Chase Cancer Center researchers suggests altering the standard care, which currently requires the removal and examination of 12 lymph nodes.

During colon cancer surgeries, lymph nodes are removed to assess whether cancer has spread. If the disease has spread, patients benefit from chemotherapy post-surgery, a treatment known to enhance survival rates. Therefore, the accurate determination of cancer spread through lymph node removal is critical.

A team led by Dr. Praveen Chatani at Fox Chase Cancer Center, using data from the National Cancer Database, studied records from 195,000 patients who had undergone colon resection surgery between 2010 and 2021. Their research focused on the likelihood of patients being "upstaged" to stage III based on how many lymph nodes were removed and tested. Patients with 18 or more nodes removed were more likely to have disease detected in the nodes compared to those with 12 to 17 nodes removed, and the chances of upstaging increased with each additional node examined.

"Removing at least 18 nodes improved the accuracy of identifying who needs chemotherapy," said Chatani. "Patients are more likely to get the right treatment after surgery and, ultimately, live longer."

The study also revealed that more than 25% of patients with their cancer upstaged to stage III were identified after lymph node removal. Specific risk factors for upstaging were identified, aiding in counseling patients pre-operation. "Patients want to know their odds of needing postoperative chemotherapy," said Chatani.

The team also identified predictive factors for upstaging, which resulted in the development of a risk calculator by co-author Jordan Fredette, MPH. This tool, once finalized, aims to inform physicians nationwide and adjust patient counseling before surgery.

The study titled, “Incidence of and Risk Factors for Radiographically Occult Nodal Metastases in Colon Cancer: Is it Time for a New Lymphadenectomy Standard?” was presented at the Annual Meeting held in Tampa, Florida.