Number of lymph nodes removed excessive?

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O Stoma Mia
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Number of lymph nodes removed excessive?

Postby O Stoma Mia » Fri Dec 29, 2017 2:06 am

Basil wrote:... I’d be interested in knowing if anyone has any thoughts on removing 42 nodes during surgery. That number seems a lot higher than other cases. I’ll ask my onc about it at my next appointment but it’s been something I’ve been wondering about.

Basil - I'd be interested in knowing what your oncologist has to say about this issue. It seems to me that harvesting a lot of lymph nodes could he viewed as damaging a person's immune system. What do you think?

...
A damaged lymphatic system means that a person is much more susceptible to illness and injury as the lymphatic system ordinarily helps the body to heal faster and better. Very few, if any, studies in any type of cancers have examined the long-time results of node removal/lymph system damage with these harms in mind.

Ref: Https://thetruthaboutcancer.com/lymph-node-removal-necessary/

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dianetavegia
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Re: Number of lymph nodes removed excessive?

Postby dianetavegia » Fri Dec 29, 2017 8:35 am

Basil, did you have rectal or colon cancer? There are more than 100 lymph nodes in the pelvic area so 17 in the abdomen might be the same as 40 in the rectal area.
Stage III cc surgery 1/7/09. 12 tx FOLFOX
Stage IV PET = 1.5cm liver met. HR 4/11/12

14 years since dx and 11 years post liver resection.
Pronounced CURED and discharged by onc

“O Lord my God, I cried out to You, And You healed me.” Psalms 30:2

Basil
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Re: Number of lymph nodes removed excessive?

Postby Basil » Fri Dec 29, 2017 8:26 pm

I was rectal, stage iii, with the tumor 7 cm from the verge. My surgeon is the colorectal surgical chief at MDA Houston and his knowledge of my case and treatment recommendations supports his resume. I have no second guesses on what he did, I’ve just been wondering about the high node number. My recovery, btw, has been stellar, both from TME and reversal.
40 y/o male (now 46), kids 11 & 14.
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

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CRguy
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Re: Number of lymph nodes removed excessive?

Postby CRguy » Fri Dec 29, 2017 8:59 pm

Interesting post OSM, and as a surgery guy myself I am always cognizant of the primum non nocere edict taught to students.
My personal take would be : do what needs to be done to get rid of the cancer
... BUTT as our sophistication matures in what we do and how we do it, we have the luxury of hindsight in many instances...
so sometimes "less is more" and I like the fact that we are at least looking at the situation
BECAUSE as you all know, I LIVE by : " you will miss more for NOT LOOKING .. than not knowing "

I also had a TME, Basil, and the en bloc resection technique used leaves no choice for the surgeon. ALL lymphatic tissue / nodes in the intact mesorectum come OUT ! Surgeons may also "harvest" other lymphovascular tissues in an attempt to assess local invasion / extension / metastasis, thereby increasing the reliability of their clinicopathological results.

Cheers all
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: Number of lymph nodes removed excessive?

Postby Basil » Fri Dec 29, 2017 9:06 pm

How many nodes did they resect from you? I would think it would be a comparable number, given the nature of the surgery, unless folks vary widely in number of nodes.
40 y/o male (now 46), kids 11 & 14.
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

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CRguy
Posts: 10473
Joined: Sun Feb 10, 2008 6:00 pm

Re: Number of lymph nodes removed excessive?

Postby CRguy » Fri Dec 29, 2017 11:59 pm

My problemo = neoadjuvant chemoradiation

radiation = nuked nodes :shock:
nuked nodes = YES all removed en bloc ... BUTT
nothing left for pathologists to actually "review"

my TME was 2007 and the whole "harvested node numbers" was not as much of a consideration then
WHICH is why I am loving this discussion now

What I / WE went through then, lays the framework for what needs to be a NEW consideration NOW

Moving forward and paying it forward ....
On The JOURNEY !!!!

Cheers
CR
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Number of lymph nodes removed excessive?

Postby mpbser » Sun Dec 31, 2017 7:26 am

My husband had 54 nodes removed the first colon surgery and then 20+ (I forget exactly how many) during his second surgery. I think the latter number exceeded 40. It worried, and still worries me, that such a high number were removed. I have a little understanding of the intestinal lymph node system which is like a "second brain." Actually, it is called the microbiota gut-brain axis.

I spoke about this with his primary oncologist and colon surgeon at Mass General before his 2nd surgery but they were extremely dismissive. I don't think they have any knowledge of microbial endocrinology whatsoever.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

tarheelmom
Posts: 168
Joined: Mon Mar 07, 2016 5:55 pm

Re: Number of lymph nodes removed excessive?

Postby tarheelmom » Sun Dec 31, 2017 10:33 am

TME with 32 nodes removed - similar to CRGuy. Everything taken along with my rectum and sigmoid colon.
52 y at dx, mom to 4
DX: RC on 2/22/2016
Stage I, T2N0M0, 0/32 LN
23 mm x 7 mm moderately differentiated invasive adenocarcinoma
3 cm from anal verge
4/12/16: ULAR, TME, & temp ileostomy
6/14/16: ileo reversal

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O Stoma Mia
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Location: On vacation. Off-line for now.

Re: Number of lymph nodes removed excessive?

Postby O Stoma Mia » Mon Jan 01, 2018 1:10 pm

Basil wrote:... I’d be interested in knowing if anyone has any thoughts on removing 42 nodes during surgery. That number seems a lot higher than other cases. I’ll ask my onc about it at my next appointment but it’s been something I’ve been wondering about.

Basil - There is a 2015 published article that may address your question. In this article, they examined over 10,000 resected lymph nodes from a total of 244 rectal cancer patients at their institution, and apparently what they found was that the median lymph node yield was 41 lymph nodes.
..One hundred seventy-three anterior resection and 71 abdominoperineal resection specimens were analyzed. Median lymph node yield was 41 lymph nodes (interquartile range, 31-52); 344 of 10,473 (3.2%) lymph nodes were positive. Lymph nodes were distributed in the mesorectum, sigmoid mesentery, and vascular pedicle in 40%, 32%, and 28% of the patients...

Reference:
Size and Distribution of Lymph Nodes in Rectal Cancer Resection Specimens.
https://www.researchgate.net/publication/273322891_Size_and_Distribution_of_Lymph_Nodes_in_Rectal_Cancer_Resection_Specimens

Steph20021
Posts: 553
Joined: Sat Dec 27, 2014 4:58 pm
Location: Ontario, Canada

Re: Number of lymph nodes removed excessive?

Postby Steph20021 » Mon Jan 01, 2018 11:08 pm

I had just over 100 lymph nodes removed in my first surgery when I lost my entire colon and right ovary. Only six were cancerous. Silly me I figured that I had pretty good odds of being cured given how many were not cancerous. I was happy at the time that my surgeon took and tested as many as he did.
DX 1/31/14 @ 33- SPS-T4a(invades visceral peri), N2a(6/106 LN), M1a(ovary) (Stage 4a) MSS; BRAF V600E
2/1/14-subtotal col, lost R ovary, temp ileo
3/14-9/14- folfox; sepsis
11/14-CT/PET: L ovary met, pelvic met, (?)ghost liver met(?)
12/14-folfiri -13 rds kept me stable from 3/15-6/15
8/15-HIPEC, NED
09/15- cea 0.9
05/16- recurrence in abdo wall and lymph nodes
01/17- pulmonary embolism
02/17- 1 wk radiation to abdo wall
08/16- on folfiri
01/18-folfox
11/18- Beacon trial-encorafenib & cetuximab

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: Number of lymph nodes removed excessive?

Postby Basil » Tue Jan 02, 2018 3:45 pm

O Stoma Mia wrote:
Basil wrote:... I’d be interested in knowing if anyone has any thoughts on removing 42 nodes during surgery. That number seems a lot higher than other cases. I’ll ask my onc about it at my next appointment but it’s been something I’ve been wondering about.

Basil - There is a 2015 published article that may address your question. In this article, they examined over 10,000 resected lymph nodes from a total of 244 rectal cancer patients at their institution, and apparently what they found was that the median lymph node yield was 41 lymph nodes.
..One hundred seventy-three anterior resection and 71 abdominoperineal resection specimens were analyzed. Median lymph node yield was 41 lymph nodes (interquartile range, 31-52); 344 of 10,473 (3.2%) lymph nodes were positive. Lymph nodes were distributed in the mesorectum, sigmoid mesentery, and vascular pedicle in 40%, 32%, and 28% of the patients...

Reference:
Size and Distribution of Lymph Nodes in Rectal Cancer Resection Specimens.
https://www.researchgate.net/publication/273322891_Size_and_Distribution_of_Lymph_Nodes_in_Rectal_Cancer_Resection_Specimens


Thank you so much for finding/quoting that! Looks like I'm right in the sweet spot.
40 y/o male (now 46), kids 11 & 14.
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)


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