Why are we focusing on 12 negative lymph nodes in patients with colon cancer given the recent evidence?
In patients undergoing colon cancer who do not have obvious advanced disease (metastatic or obvious local invasion) the determination of whether they get life-extending postoperative chemotherapy is often based on whether or not there is evidence of micro-metastatic disease in the lymph node (LN) bearing tissue (mesentery) that is removed with the colon specimen. Whether or not enough negative lymph nodes (revealing no metastatic disease) has been evaluated depends on several factors. The risk of a false negative assessment of the lymph nodes decreases as the number of sampled lymph nodes increases. There is nothing magic about the number 12, but multiple studies have found that when at least 12 negative lymph nodes are removed more evidence of metastases is found and therefore more patients might properly get life extending chemotherapy. Some surgeons have balked at this metric because getting at least twelve negative LNs evaluated is a group activity. Surgeons remove the specimen but
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