Lymph node counts
LN removal counts provide a way of measuring the adequacy of surgical
staging to guide adjuvant therapy and prognosis(5,33).
Improved OS is related to a higher number of LNs removed, especially in
patients with high and intermediate risk EC(36).
Literature shows a wide range of LN removal
counts(20,34) suggesting the subjective definition of
adequate LND is biased when evaluating its prognostic and therapeutic
efficacy. Studies have shown that patients have improved survival when
>10–12 LNs were removed(5,33). In
contrast one study suggested that 21–25 nodes are required for adequate
nodal assessment(38). This was directly opposed by
Benedetti et al. showing no improved survival with removal of 20 or more
LNs(34). These mixed findings support the
ESMO-ESGO-ESTRO 2016 consensus that systematic LND should be defined by
removing more than 10 LNs(5). This calls into question
the ASTEC trial in which less than 10 LNs were removed in 35% of
surgeries(20).