{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:08:52Z","timestamp":1790359732331,"version":"4.1.0"},"reference-count":51,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Colorectal cancer is the third most common cancer worldwide, making lymph node recovery critical for treatment decisions and prognosis. The relationship between body mass index (BMI) and the number of lymph nodes retrieved during laparoscopic and open surgeries remains controversial. This study aimed to evaluate whether surgical approach and BMI influence lymph node retrieval in colon cancer surgeries. Methods: A retrospective analysis was conducted on 560 patients who underwent colon cancer surgery at a single institution between 2018 and 2023. The average number of lymph nodes retrieved during laparoscopic and open procedures was compared. Distribution analysis using violin plots was performed to assess the pattern of lymph node yield between surgical approaches. Additionally, the impact of BMI on lymph node recovery was assessed. All surgeries were performed by a standardized surgical team using consistent fat clearance techniques. Results: The mean number of lymph nodes retrieved was 15.89 \u00b1 0.84 for laparoscopic surgeries and 15.98 \u00b1 0.50 for open surgeries, with no statistically significant difference (p = 0.9166). The violin plot analysis confirmed overlapping distributions between the two surgical approaches, with no significant difference (p = 0.6270). BMI also showed no significant effect on the number of lymph nodes removed during surgery. The consistency in outcomes was attributed to standardized surgical practices across all cases. Conclusions: Laparoscopic and open surgical approaches yield comparable lymph node recovery in colon cancer surgeries, both in terms of mean values and overall distribution patterns, regardless of patient BMI. These findings emphasize the importance of standardized surgical techniques in ensuring reliable outcomes and suggest that both approaches are equally effective in meeting oncological standards for lymph node retrieval.<\/jats:p>","DOI":"10.3390\/cancers17081312","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T03:39:16Z","timestamp":1744601956000},"page":"1312","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Breaking Myths: Comparable Outcomes in Lymph Node Analysis Across Surgical Methods"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5751-9263","authenticated-orcid":false,"given":"Salvatore","family":"Pezzino","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, 94100 Enna, Italy"},{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6109-5005","authenticated-orcid":false,"given":"Tonia","family":"Luca","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"},{"name":"Department of Medical, Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariacarla","family":"Castorina","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Fuccio Sanz\u00e0","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Magro","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7067-900X","authenticated-orcid":false,"given":"Stefano","family":"Puleo","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ornella","family":"Coco","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Castorina","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cGB Morgagni\u201d, 95125 Catania, Italy"},{"name":"Department of Medical, Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1053\/j.gastro.2020.03.016","article-title":"Estimation of Absolute Risk of Colorectal Cancer Based on Healthy Lifestyle, Genetic Risk, and Colonoscopy Status in a Population-Based Study","volume":"159","author":"Carr","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_2","first-page":"13","article-title":"Modifiable Lifestyle Factors That Could Reduce the Incidence of Colorectal Cancer in New Zealand","volume":"129","author":"Richardson","year":"2016","journal-title":"NZ Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1053\/j.gastro.2018.08.044","article-title":"Healthy Lifestyle Factors Associated With Lower Risk of Colorectal Cancer Irrespective of Genetic Risk","volume":"155","author":"Carr","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1615\/CritRevOncog.2020035135","article-title":"Microbiome Conundrum in Colon Cancer: Development, Progression, and Therapeutics","volume":"25","author":"Malla","year":"2020","journal-title":"Crit. Rev. Oncog."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chen, K., Collins, G., Wang, H., and Toh, J.W.T. (2020). Linking Obesity with Colorectal Cancer: Epidemiology and Molecular Mechanisms. Cancers, 12.","DOI":"10.3390\/cancers12061408"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Miranda, B.C.J., Tustumi, F., Nakamura, E.T., Shimanoe, V.H., Kikawa, D., and Waisberg, J. (2024). Obesity and Colorectal Cancer: A Narrative Review. Medicina, 60.","DOI":"10.3390\/medicina60081218"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5177","DOI":"10.3748\/wjg.v20.i18.5177","article-title":"Obesity and Colorectal Cancer: Role of Adipokines in Tumor Initiation and Progression","volume":"20","author":"Riondino","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_8","unstructured":"Akbulut, G., and Yilmaz, M. (2024). Colorectal Cancer and Associated Genetic, Lifestyle, Cigarette, Nargileh-Hookah Use, and Alcohol Consumption Risk Factors. BMC Cancer, 24."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101174","DOI":"10.1016\/j.tranon.2021.101174","article-title":"Global Colorectal Cancer Burden in 2020 and Projections to 2040","volume":"14","author":"Xi","year":"2021","journal-title":"Transl. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"8065972","DOI":"10.1155\/2020\/8065972","article-title":"Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study","volume":"2020","author":"Lei","year":"2020","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s40258-019-00482-7","article-title":"Budget Impact Analysis of Molecular Lymph Node Staging Versus Conventional Histopathology Staging in Colorectal Carcinoma","volume":"17","author":"Archilla","year":"2019","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Yu, Y.-L., Hsu, Y.-J., Liao, C.-K., Lin, Y.-C., You, J.-F., Tsai, W.-S., Jong, B.-K., and Chern, Y.-J. (2023). Advantage of Laparoscopic Surgery in Patients with Generalized Obesity Operated for Colorectal Malignancy: A Retrospective Cohort Study. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1062746"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/cam4.671","article-title":"Laparoscopic Surgery for Patients with Colorectal Cancer Produces Better Short-term Outcomes with Similar Survival Outcomes in Elderly Patients Compared to Open Surgery","volume":"5","author":"Moon","year":"2016","journal-title":"Cancer Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/codi.14107","article-title":"The Effect of Increasing Body Mass Index on Laparoscopic Surgery for Colon and Rectal Cancer","volume":"20","author":"Bell","year":"2018","journal-title":"Color. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.ijsu.2014.05.057","article-title":"A Comparative Study on Two Different Pathological Methods to Retrieve Lymph Nodes Following Gastrectomy","volume":"12","author":"Lavy","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"425","DOI":"10.7150\/jca.2.425","article-title":"A Meta-Analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Colorectal Cancer","volume":"2","author":"Ohtani","year":"2011","journal-title":"J. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1002\/ags3.12599","article-title":"Laparoscopic versus Open Resection for Stage II\/III Rectal Cancer in Obese Patients: A Multicenter Propensity Score-Based Analysis of Short- and Long-Term Outcomes","volume":"7","author":"Akagi","year":"2023","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e072244","DOI":"10.1136\/bmjopen-2023-072244","article-title":"Association between the Number of Retrieved Lymph Nodes and Demographic\/Tumour-Related Characteristics in Colorectal Cancer: A Systematic Review and Meta-Analysis","volume":"13","author":"Liu","year":"2023","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/wjcs.wjcs_15_22","article-title":"The Association between Body Mass Index and Lymph Node Harvest After Elective Colon Cancer Resections","volume":"11","author":"Cataneo","year":"2022","journal-title":"World J. Color. Surg."},{"key":"ref_20","first-page":"11789","article-title":"The Impact of Body Mass Index on the Clinicopathological and Prognostic Factors of Colorectal Cancer in Saudi Arabia","volume":"12","author":"Aldaqal","year":"2020","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1463-1318.2006.01044.x","article-title":"The Importance of Accurate Pathological Assessment of Lymph Node Involvement in Colorectal Cancer","volume":"8","author":"Schofield","year":"2006","journal-title":"Color. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/ases.12340","article-title":"Is It Important to Palpate Lymph Nodes in Open Surgery for Colorectal Cancer?","volume":"10","author":"Yamaoka","year":"2016","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"410","DOI":"10.3393\/ac.2022.00143.0020","article-title":"Prognostic Significance of Lymph Node Yield on Oncologic Outcomes According to Tumor Response after Preoperative Chemoradiotherapy in Rectal Cancer Patients","volume":"39","author":"Ryu","year":"2023","journal-title":"Ann. Coloproctol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/s41392-023-01576-4","article-title":"Lymph Node Metastasis in Cancer Progression: Molecular Mechanisms, Clinical Significance and Therapeutic Interventions","volume":"8","author":"Ji","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Fujino, S., Miyoshi, N., Ohue, M., Ito, A., Yasui, M., Ogino, T., Takahashi, H., Uemura, M., Matsuda, C., and Yamamoto, H. (2020). A New Fat-Dissociation Method to Detect Lymph Nodes in Colorectal Cancer: A Prospective Randomized Study. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-77195-8"},{"key":"ref_26","first-page":"2495","article-title":"Lymph Node Retrieval after Dissolution of Surrounding Adipose Tissue for Pathological Examination of Colorectal Cancer","volume":"15","author":"Maeda","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"277","DOI":"10.4240\/wjgs.v12.i6.277","article-title":"Efficacy of the Fat-Dissociation Method for Nodal Harvesting in Gastric Cancer","volume":"12","author":"Kinami","year":"2020","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/1066896920975501","article-title":"Using the Fat-Clearing Technique to Improve Lymph Node Retrieval in Colorectal Cancer","volume":"29","author":"Yeh","year":"2021","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4615","DOI":"10.1002\/cam4.2372","article-title":"Increased Lymph Node Yield Indicates Improved Survival in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy","volume":"8","author":"Wang","year":"2019","journal-title":"Cancer Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"877","DOI":"10.4251\/wjgo.v11.i10.877","article-title":"Fat Clearance and Conventional Fixation Identified ypN0 Rectal Cancers Following Intermediate Neoadjuvant Radiotherapy Have Similar Long-Term Outcomes","volume":"11","author":"Chen","year":"2019","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/DCR.0000000000002323","article-title":"The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer","volume":"65","author":"Vogel","year":"2021","journal-title":"Dis. Colon Rectum"},{"key":"ref_32","first-page":"1932","article-title":"Prognostic Impact of Increased Lymph Node Yield in Colorectal Cancer Patients with Synchronous Liver Metastasis: A Population-Based Retrospective Study of the US Database and a Chinese Registry","volume":"109","author":"Jiao","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.3748\/wjg.v20.i8.1951","article-title":"Colorectal Cancer and Lymph Nodes: The Obsession with the Number 12","volume":"20","author":"Scilletta","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"179","DOI":"10.4240\/wjgs.v8.i3.179","article-title":"Assessment of Lymph Node Involvement in Colorectal Cancer","volume":"8","author":"Ong","year":"2016","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12957-020-1802-6","article-title":"How Does Lymph Node Yield Affect Survival Outcomes of Stage I and II Colon Cancer?","volume":"18","author":"Foo","year":"2020","journal-title":"World J. Surg. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1002\/ijc.22996","article-title":"Lymphangiogenesis in Colorectal Cancer\u2014Prognostic and Therapeutic Aspects","volume":"121","author":"Dicko","year":"2007","journal-title":"Int. J. Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5356","DOI":"10.3390\/curroncol28060447","article-title":"Pathological Features and Prognostication in Colorectal Cancer","volume":"28","author":"Chen","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Zhou, S., Wang, X., Zhao, C., Liu, Q., Zhou, H., Zheng, Z., Zhou, Z., Wang, X., and Liang, J. (2019). Laparoscopic vs Open Colorectal Cancer Surgery in Elderly Patients: Short- and Long-Term Outcomes and Predictors for Overall and Disease-Free Survival. BMC Surg., 19.","DOI":"10.1186\/s12893-019-0596-3"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/lap.2012.0276","article-title":"Laparoscopic-Assisted Versus Open Surgery for Colorectal Cancer: Short- and Long-Term Outcomes Comparison","volume":"23","author":"Biondi","year":"2013","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s12672-023-00824-x","article-title":"Resection Margins, Lymph Node Harvest and 3 Year Survival in Open and Laparoscopic Colorectal Cancer Surgery; a Prospective Cohort Study","volume":"14","author":"Lokuhetty","year":"2023","journal-title":"Discov. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Chiu, C.-C., Lin, W.-L., Shi, H.-Y., Huang, C.-C., Chen, J.-J., Su, S.-B., Lai, C.-C., Chao, C.-M., Tsao, C.-J., and Chen, S.-H. (2019). Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060875"},{"key":"ref_42","first-page":"e24635","article-title":"Comparison of Short-Term Results of Laparoscopic and Open Surgeries for Colorectal Cancer: A Single-Center Experience","volume":"14","author":"Durak","year":"2022","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/SLE.0b013e3182432b49","article-title":"Lymph Node Harvested in Laparoscopic versus Open Colorectal Cancer Approaches: A Meta-Analysis","volume":"22","author":"Wu","year":"2012","journal-title":"Surg. Laparosc. Endosc. Percutan Tech."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2707","DOI":"10.1111\/ans.17227","article-title":"Does the Body Mass Index Impact Lymph Node Yield for Colorectal Cancer Resection, and Does Operative Approach Influence This: A Review of Bi-National Colorectal Cancer Audit Database","volume":"91","author":"Cheong","year":"2021","journal-title":"ANZ J. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1055\/s-0031-1295686","article-title":"Obesity and Colorectal Cancer","volume":"24","author":"Kosinski","year":"2011","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.amjsurg.2009.12.012","article-title":"Does Obesity Impact Lymph Node Retrieval in Colon Cancer Surgery?","volume":"200","author":"Linebarger","year":"2010","journal-title":"Am. J. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1007\/DCR.0b013e3181b14eaf","article-title":"The Clinical Significance of Fat Clearance Lymph Node Harvest for Invasive Rectal Adenocarcinoma Following Neoadjuvant Therapy","volume":"52","author":"Wang","year":"2009","journal-title":"Dis. Colon Rectum"},{"key":"ref_48","first-page":"e53792","article-title":"Enzymatic Fat Dissolution Improves Detection of Small Lymph Nodes in Colon Cancer Surgery","volume":"16","author":"Kajitani","year":"2024","journal-title":"Cureus"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Zhong, H., Zhou, L., Liao, S., Tang, J., Yue, L., Mo, M., and Zhong, Y. (2022). Effects of a Fixed Nurse Team in the Orthopaedic Surgery Operating Room on Work Efficiency and Patient Outcomes: A Propensity Score-Matched Historically Controlled Study. BMC Nurs., 21.","DOI":"10.1186\/s12912-022-01027-5"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.amjsurg.2008.03.002","article-title":"Surgical Team Behaviors and Patient Outcomes","volume":"197","author":"Mazzocco","year":"2009","journal-title":"Am. J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ijsu.2018.03.044","article-title":"The Impact of Improving Teamwork on Patient Outcomes in Surgery: A Systematic Review","volume":"53","author":"Sun","year":"2018","journal-title":"Int. J. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/8\/1312\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:13:56Z","timestamp":1760030036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/8\/1312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":51,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["cancers17081312"],"URL":"https:\/\/doi.org\/10.3390\/cancers17081312","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}