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Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance
Article first published online: 10 FEB 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 9, pages 1840–1848, 1 May 2009
How to Cite
Dillman, R. O., Aaron, K., Heinemann, F. S. and McClure, S. E. (2009), Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance. Cancer, 115: 1840–1848. doi: 10.1002/cncr.24185
- Issue published online: 20 APR 2009
- Article first published online: 10 FEB 2009
- Manuscript Accepted: 20 OCT 2008
- Manuscript Revised: 23 SEP 2008
- Manuscript Received: 30 JUL 2008
- Hoag Hospital Foundation
- colon cancer;
- colorectal fellowship training;
- lymph nodes;
- pathology procedures
Identification of ≥12 lymph nodes in resected colon cancer specimens has been endorsed as a quality indicator.
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.
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.
Anatomic location, colorectal surgical training, and case volume were strongly correlated with the number of lymph nodes identified. Cancer 2009. © 2009 American Cancer Society.