Major staging guidance expects at least 12 lymph nodes to be examined in a colorectal cancer resection, and a low count raises the chance that a node-positive cancer is understaged as node-negative. When the first search yields fewer, a second look, sometimes with fat clearance, often finds more.
The number examined belongs in the report, alongside the number involved, so the oncologist can judge how reliable a pN0 is.
- Report both the number of nodes examined and the number involved.
- If fewer than 12 nodes are found, search again before signing out.
- Note when neoadjuvant therapy may explain a low yield.
- Flag a low node count in a pN0 report so adjuvant decisions take it into account.
Why it matters
A pN0 from five nodes is not the same reassurance as a pN0 from twenty.
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