Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance

Authors

  • Robert O. Dillman MD,

    Corresponding author
    1. Hoag Cancer Center, Hoag Memorial Hospital Presbyterian, Newport Beach, California
    2. Department of Medical Oncology, Hoag Memorial Hospital Presbyterian, Newport Beach, California
    • Hoag Cancer Center, One Hoag Drive, Building 41, Newport Beach, CA 92658===

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    • Fax: (949) 764-8102

  • Kenneth Aaron MD,

    1. Department of Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach, California
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  • F. Scott Heinemann MD,

    1. Department of Pathology, Hoag Memorial Hospital Presbyterian, Newport Beach, California
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  • Stephanie E. McClure CTR

    1. Hoag Cancer Center, Hoag Memorial Hospital Presbyterian, Newport Beach, California
    2. Cancer Registry, Hoag Memorial Hospital Presbyterian, Newport Beach, California
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Abstract

BACKGROUND:

Identification of ≥12 lymph nodes in resected colon cancer specimens has been endorsed as a quality indicator.

METHODS:

The Hoag Hospital cancer registry was used to identify patients diagnosed with colon cancer. The proportion of colon cancer specimens for which ≥12 lymph nodes were identified was determined by anatomic location, stage of disease, patient age, and operating surgeon. Survival was correlated with stage and with whether ≥12 lymph nodes were identified.

RESULTS:

Pathology procedural changes in 1998 were associated with an increase in the average number of lymph nodes identified from 8.0 to 14.5 (P < .0001); therefore, analysis was limited to 574 patients who underwent surgical resection of colon adenocarcinoma during 1998 to 2005. Identification of ≥12 lymph nodes varied from 57% to 83% by 7 anatomic locations (P < .0001), from 65% to 75% by 5 age cohorts (P = .027), from 59% to 73% by 4 general stages of disease (P = .004), and from 53% to 80% among 12 surgeons who performed at least 17 resections (P = .014). The proportion of resections in which ≥12 lymph nodes were identified was higher for 3 colorectal fellowship-trained surgeons compared with the other 9 surgeons (77% vs 63%, P = .0007), and with 30 surgeons who each performed <10 resections (77% vs 51%, P < .0001). Identification of ≥12 lymph nodes was associated with better survival for patients with stage I (P = .016) and stage II (P = .021) disease.

CONCLUSIONS:

Anatomic location, colorectal surgical training, and case volume were strongly correlated with the number of lymph nodes identified. Cancer 2009. © 2009 American Cancer Society.

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