{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:44:28Z","timestamp":1787237068872,"version":"build-2736575974"},"reference-count":44,"publisher":"Harborside Press, LLC","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Accurate identification of positive lymph nodes after colectomy is essential for optimizing oncologic outcomes, as it directly informs the use of adjuvant chemotherapy in nonmetastatic colon cancer. The current lymph node target required for accurate staging has remained unchanged for decades. This study sought to identify a data-driven lymph node threshold that better optimizes oncologic outcomes.\n                    <jats:bold>Methods:<\/jats:bold>\n                    The National Cancer Database was queried for patients with clinically node-negative colon adenocarcinoma undergoing curative-intent resection between 2010 and 2021. Variables associated with nodal positivity were identified and the likelihood of nodal positivity with increasing lymph node examination targets was assessed.\n                    <jats:bold>Results:<\/jats:bold>\n                    Clinically node-negative patients who underwent curative-intent colectomy (n=195,009) were found to be node-positive in 26.3% of cases. Characteristics associated with nodal positivity included lymphovascular or perineural invasion, poor differentiation, microsatellite stability, age &lt;50 years, and sigmoid primary. The number of nodes examined correlated with increased odds of pathologic node-positive disease at varying rates (11.2% per node for the first 10 nodes, 1.2% per node from 11\u201326 nodes, with no correlation beyond 26 nodes). Examination of \u226518 nodes was independently associated with pathologic nodal positivity (odds ratio [OR], 1.11), receipt of adjuvant chemotherapy (OR, 1.10), and improved median overall survival (hazard ratio, 0.88) when compared with those with 12 to 17 nodes examined (all\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.05).\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Our study demonstrates the superiority of a predetermined higher lymph node examination target (\u226518 nodes) compared with the current standard. This target more frequently identified stage III disease and was associated with higher rates of adjuvant chemotherapy use and improved overall survival.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2025.7122","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T21:08:35Z","timestamp":1774300115000},"source":"Crossref","is-referenced-by-count":1,"title":["Redefining the Lymphadenectomy Standard to Avoid Understaging in Oncologic Colectomies"],"prefix":"10.6004","volume":"24","author":[{"given":"Praveen D.","family":"Chatani","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan D.","family":"Fredette","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosmi P.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea S.","family":"Porpiglia","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie H.","family":"Greco","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay S.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Farma","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"Villano","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"CA Cancer J Clin","first-page":"233","article-title":"Colorectal cancer statistics, 2023","volume":"73","author":"Siegel RL","year":"2023","unstructured":"Siegel RL, Wagle NS, Cercek A,  Colorectal cancer statistics, 2023. CA Cancer J Clin 2023;73:233\u2013254."},{"key":"B2","series-title":"Br J Surg","first-page":"1165","article-title":"Detection of lymph node metastases in colorectal carcinoma before and after fat clearance","volume":"76","author":"Scott KW","year":"1989","unstructured":"Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165\u20131167."},{"key":"B3","series-title":"Int J Colorectal Dis","first-page":"623","article-title":"The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate?","volume":"35","author":"Cai Y","year":"2020","unstructured":"Cai Y, Cheng G, Lu X,  The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate? Int J Colorectal Dis 2020;35:623\u2013631."},{"key":"B4","series-title":"World J Surg Oncol","first-page":"22","article-title":"How does lymph node yield affect survival outcomes of stage I and II colon cancer?","volume":"18","author":"Foo CC","year":"2020","unstructured":"Foo CC, Ku C, Wei R,  How does lymph node yield affect survival outcomes of stage I and II colon cancer? World J Surg Oncol 2020;18:22."},{"key":"B5","series-title":"Surg Oncol","first-page":"101806","article-title":"Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: the more the better?","volume":"43","author":"Simoes P","year":"2022","unstructured":"Simoes P, Fernandes G, Costeira B,  Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: the more the better? Surg Oncol 2022;43:101806."},{"key":"B6","series-title":"Cancer Control","first-page":"10732748211064034","article-title":"Examining more lymph nodes may improve the prognosis of patients with right colon cancer: determining the optimal minimum lymph node count","volume":"28","author":"Wu W","year":"2021","unstructured":"Wu W, Li D, Ma W,  Examining more lymph nodes may improve the prognosis of patients with right colon cancer: determining the optimal minimum lymph node count. Cancer Control 2021;28:10732748211064034."},{"key":"B7","series-title":"J Am Coll Surg","first-page":"520","article-title":"Variation in lymph node assessment for colon cancer at the tumor, surgeon, and hospital level","volume":"238","author":"Egger ME","year":"2024","unstructured":"Egger ME, Feygin Y, Kong M,  Variation in lymph node assessment for colon cancer at the tumor, surgeon, and hospital level. J Am Coll Surg 2024;238:520\u2013528."},{"key":"B8","series-title":"World J Surg","first-page":"1292","article-title":"Prognostic impact of main lymph node metastasis in patients with colon cancer","volume":"47","author":"Sugiura K","year":"2023","unstructured":"Sugiura K, Seo Y, Tajima Y,  Prognostic impact of main lymph node metastasis in patients with colon cancer. World J Surg 2023;47:1292\u20131302."},{"key":"B9","series-title":"Dis Colon Rectum","first-page":"148","article-title":"The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer","volume":"65","author":"Vogel JD","year":"2022","unstructured":"Vogel JD, Felder SI, Bhama AR,  The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. 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Front Oncol 2021;11:667477."},{"key":"B18","series-title":"Am J Surg","first-page":"753","article-title":"Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon","volume":"223","author":"Artinyan A","year":"2022","unstructured":"Artinyan A, Wai C, Zhu R,  Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon. Am J Surg 2022;223:753\u2013758."},{"key":"B19","series-title":"Cancer","first-page":"1859","article-title":"Prognosis of node-positive colon cancer","volume":"67","author":"Cohen AM","year":"1991","unstructured":"Cohen AM, Tremiterra S, Candela F,  Prognosis of node-positive colon cancer. 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CA Cancer J Clin 2023;73:233\u2013254."},{"key":"B2","series-title":"Br J Surg","first-page":"1165","article-title":"Detection of lymph node metastases in colorectal carcinoma before and after fat clearance","volume":"76","author":"Scott KW","year":"1989","unstructured":"Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165\u20131167."},{"key":"B3","series-title":"Int J Colorectal Dis","first-page":"623","article-title":"The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate?","volume":"35","author":"Cai Y","year":"2020","unstructured":"Cai Y, Cheng G, Lu X,  The re-evaluation of optimal lymph node yield in stage II right-sided colon cancer: is a minimum of 12 lymph nodes adequate? 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Surg Oncol 2022;43:101806."},{"key":"B6","series-title":"Cancer Control","first-page":"10732748211064034","article-title":"Examining more lymph nodes may improve the prognosis of patients with right colon cancer: determining the optimal minimum lymph node count","volume":"28","author":"Wu W","year":"2021","unstructured":"Wu W, Li D, Ma W,  Examining more lymph nodes may improve the prognosis of patients with right colon cancer: determining the optimal minimum lymph node count. Cancer Control 2021;28:10732748211064034."},{"key":"B7","series-title":"J Am Coll Surg","first-page":"520","article-title":"Variation in lymph node assessment for colon cancer at the tumor, surgeon, and hospital level","volume":"238","author":"Egger ME","year":"2024","unstructured":"Egger ME, Feygin Y, Kong M,  Variation in lymph node assessment for colon cancer at the tumor, surgeon, and hospital level. J Am Coll Surg 2024;238:520\u2013528."},{"key":"B8","series-title":"World J Surg","first-page":"1292","article-title":"Prognostic impact of main lymph node metastasis in patients with colon cancer","volume":"47","author":"Sugiura K","year":"2023","unstructured":"Sugiura K, Seo Y, Tajima Y,  Prognostic impact of main lymph node metastasis in patients with colon cancer. World J Surg 2023;47:1292\u20131302."},{"key":"B9","series-title":"Dis Colon Rectum","first-page":"148","article-title":"The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer","volume":"65","author":"Vogel JD","year":"2022","unstructured":"Vogel JD, Felder SI, Bhama AR,  The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum 2022;65:148\u2013177."},{"key":"B10","series-title":"N Engl J Med","first-page":"2343","article-title":"Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer","volume":"350","author":"Andre T","year":"2004","unstructured":"Andre T, Boni C, Mounedji-Boudiaf L,  Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004;350:2343\u20132351."},{"key":"B11","article-title":"NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. Version 3.2024","author":"Benson AB","unstructured":"Benson AB, Venook AP, Adam M,  NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. Version 3.2024. Accessed December 1, 2025. To view the most recent version, visit https:\/\/www.nccn.org"},{"key":"B12","series-title":"Ann Surg Open","first-page":"e338","article-title":"Inadequate lymph node yield: an inadequate indication for adjuvant chemotherapy in stage II colon cancer","volume":"4","author":"Zambeli-Ljepovic A","year":"2023","unstructured":"Zambeli-Ljepovic A, Hoffman D, Barnes KE,  Inadequate lymph node yield: an inadequate indication for adjuvant chemotherapy in stage II colon cancer. Ann Surg Open 2023;4:e338."},{"key":"B13","series-title":"Ann Surg Oncol","first-page":"683","article-title":"The National Cancer Data Base: a powerful initiative to improve cancer care in the United States","volume":"15","author":"Bilimoria KY","year":"2008","unstructured":"Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008;15:683\u2013690."},{"key":"B14","series-title":"Ann Surg Oncol","first-page":"1604","article-title":"Incident cases captured in the National Cancer Database compared with those in U.S. population based central cancer registries in 2012-2014","volume":"26","author":"Mallin K","year":"2019","unstructured":"Mallin K, Browner A, Palis B,  Incident cases captured in the National Cancer Database compared with those in U.S. population based central cancer registries in 2012-2014. Ann Surg Oncol 2019;26:1604\u20131612."},{"key":"B15","series-title":"Stat Med","first-page":"3055","article-title":"Estimating regression models with unknown break-points","volume":"22","author":"Muggeo VM","year":"2003","unstructured":"Muggeo VM. Estimating regression models with unknown break-points. 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Front Oncol 2021;11:667477."},{"key":"B18","series-title":"Am J Surg","first-page":"753","article-title":"Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon","volume":"223","author":"Artinyan A","year":"2022","unstructured":"Artinyan A, Wai C, Zhu R,  Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon. Am J Surg 2022;223:753\u2013758."},{"key":"B19","series-title":"Cancer","first-page":"1859","article-title":"Prognosis of node-positive colon cancer","volume":"67","author":"Cohen AM","year":"1991","unstructured":"Cohen AM, Tremiterra S, Candela F,  Prognosis of node-positive colon cancer. 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