The impact on nodal staging of lymphatic mapping in carcinoma of the colon and rectum

Although the majority of individuals undergoing apparently curative resection for carcinoma of the colon rectum who are found to be without evidence of metastatic disease in the regional lymph nodes will remain free of disease, approximately 20% to 30% of these individuals will develop recurrent disease and die. This may, in part, be due to understaging of the disease. For this reason, there has been increasing interest in approaches to improving staging of all solid tumors, including carcinoma of the colon and rectum. Lymphatic mapping has revolutionized the management of patients with cutaneous melanoma and breast cancer and has been demonstrated to more accurately stage patients with solid tumors. Our investigations as well as others have taken a number of strategies to improving the staging of individuals of colorectal cancer patients with apparently node-negative disease, including the development of a novel ex vivo lymphatic mapping technique. This article summarizes our and other investigations into improved staging of colorectal cancer with an emphasis on the impact of lymphatic mapping on improving the accuracy of staging of apparently node-negative colorectal cancer patients.