Method of specimen fixation and pathological dissection of colorectal cancer influences retrieval of lymph nodes and tumour nodal stage

Eur J Surg Oncol. 2000 Dec;26(8):758-62. doi: 10.1053/ejso.2000.0999.


Introduction: There is now evidence that meticulous specimen dissection may 'upstage' around one-quarter of colorectal cancers from node negative to node positive, although there is much debate as to how to achieve this: some authors prefer fat clearance techniques while others have opted for more conventional lymph-node retrieval with manual specimen 'breadknifing' and lymph-node palpation. While fat clearance is probably the optimum technique, it is time-consuming, costly and does not provide rapid diagnostic results.

Methods: A prospective pathological study of 50 colorectal cancer resections was conducted with 100 comparison cases, the study group receiving at least an additional 24-h fixation of the mesocolonic or mesorectal fat in 10% aqueous formaldehyde prior to specimen dissection.

Results: The percentage of node-negative colorectal cancer was significantly lower in the study group compared with the matched comparison group: (18) 36% compared with (55) 55% of comparison cases.

Conclusions: Effective lymph-node retrieval techniques require mesocolic/mesorectal fat to be adequately fixed prior to pathological dissection. This study suggests that satisfactory lymph-node retrieval is possible without fat clearance, provided the mesenteric fat is suitably fixed prior to colorectal cancer specimen dissection.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Biopsy
  • Colorectal Neoplasms / pathology*
  • Humans
  • Lymph Node Excision / methods*
  • Neoplasm Staging / methods
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Specimen Handling / methods
  • Tissue Fixation / methods*