Staging Accuracy in Colorectal Cancer: A Pathologic and Therapeutic Dilemma

Colorectal cancer is one of the most prevalent and leading causes of cancer death worldwide [1]. The survival of patients with potentially curable colorectal cancer is mainly determined by pathologic tumor and lymph node staging. In locoregional disease, the extent of lymph node involvement is the most significant indicator for disease freeand overall survival rates [2]. Currently, the American Joint Committee on Cancer (AJCC) the tumor node metastasis (TNM) staging system is widely used for staging colorectal cancer. According to this staging system, lymph node staging is defined based on the number of involved lymph nodes [3]. Evaluation of at least 12 lymph nodes is currently considered as an adequate node staging in colorectal cancer [4]. However, despite advances in colorectal surgery, inadequate lymph nodes examination remains a common practice in resected colorectal cancer [5,6]. This pitfall is more prominent in the rectal location, particularly in cases receiving neoadjuvant chemoradiation [5,7]. In an analytical review, the mean total number of lymph nodes examined was 10.9, while 5.4% of patients having no lymph node identified and only 41.2% of all patients had adequate (≥12) lymph node evaluation [5]. Insufficient lymph nodes staging of colorectal cancer can potentially lead to understaging of patients with stage III and categorizing these tumor as stage I and II disease [8]. Subsequently, it causes a significant clinical challenge for predicting the prognosis and determining adjuvant treatments [2].