Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.8996
Revised: October 17, 2013
Accepted: November 12, 2013
Published online: December 21, 2013
Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive tract. Although the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes cannot be considered a measure of successful cancer surgery, an adequate lymph node count should be guaranteed to accurately assess the N-stage through the number of involved nodes, lymph node ratio, number of negative nodes, ratio of negative to positive nodes, and log odds, i.e., the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes in digestive carcinomas. As lymphadenectomy is not without complications, sentinel node mapping has been used as the rational procedure to select patients with early digestive carcinoma in whom nodal dissection may be omitted or a more limited nodal dissection may be preferred. However, due to anatomical and technical issues, sentinel node mapping and nodal basin dissection are not yet the standard of care in early digestive cancer. Moreover, in light of the biological, prognostic and therapeutic impact of tumor budding and tumor deposits, two epithelial-mesenchymal transition-related phenomena that are involved in tumor progression, the role of staging and surgical procedures in digestive carcinomas could be redefined.
Core tip: We summarize the current knowledge on the assessment of nodal status and nodal staging in digestive carcinomas and highlight the prognostic impact of two epithelial-mesenchymal transition-related phenomena, tumor budding and tumor deposits, that are involved in tumor progression. In light of the biological, prognostic and therapeutic impact of these phenomena, the role of staging and surgical procedures in digestive carcinoma could be reevaluated and redefined.