Can GEWF Solution Improve the Retrieval of Lymph Nodes from Colorectal Cancer Resections?(Glacial Acetic Acid, Ethanol, Distilled Water, Formaldehyde) (Clinical Report‪)‬

In the United States, cancer of the colon and rectum has the unfortunate designation as the second leading cause of cancer death. (1) The principal treatment modality consists of surgical resection of the colon or rectum including the pericolonic fatty tissue. Lymph node (LN) retrieval from the pericolonic fatty tissue is necessary for proper tumor staging and is the most important prognostic factor in colorectal cancer. (2,3) The adequacy of LN retrieval has also been linked to prognosis in colorectal cancer patients. Increased LN retrieval is linked to increased survival. Retrieving fewer than 7 LNs is associated with understaging and a worse prognosis for patients with stage II colon cancer. (4) Despite this association of adequate LN retrieval with proper staging, there is no consensus on the minimum number of lymph nodes required for adequate staging. In fact, the minimums vary by author, from as few as 6 LNs up to 17 per case. (5) Goldstein (6) has suggested that the predictive probability of discovering a single LN metastasis increases with the number of retrieved nodes. Further, there is no minimum number of nodes that can accurately predict staging. He suggests that all LNs should be submitted, down to 1 mm in size. Others have suggested that the retrieval of more than 40 LNs is required to properly assess early stage colon cancer.