title: Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer.
abstract: OBJECTIVE
  For gastric and pancreatic cancer, regional lymph node evaluation is important to accurately stage disease in a patient and may be associated with improved survival. We hypothesized that National Comprehensive Cancer Network (NCCN), National Cancer Institute (NCI)-designated institutions, and high-volume hospitals examine more lymph nodes for gastric and pancreatic malignant neoplasms than do low-volume centers and community hospitals.
  
  
  METHODS
  Volume-outcome study.
  
  
  METHODS
  Academic research.
  
  
  METHODS
  Using the National Cancer Data Base (January 1, 2003, to December 31, 2004), patients were identified who underwent resection for gastric (n = 3088) and pancreatic (n = 1130 [pancreaticoduodenectomy only]) cancer.
  
  
  METHODS
  Multivariable logistic regression analysis was used to assess the effect of hospital type and volume on nodal evaluation (>or=15 nodes).
  
  
  RESULTS
  Only 23.2% of patients with gastric cancer and 16.4% of patients with pancreatic cancer in the United States underwent evaluation of at least 15 lymph nodes. Patients undergoing surgery had more lymph nodes examined at NCCN-NCI hospitals than at community hospitals (median, 12 vs 6 for gastric cancer and 9 vs 6 for pancreatic cancer; P < .001). Patients at highest-volume hospitals had more lymph nodes examined than patients at low-volume hospitals (median, 10 vs 6 for gastric cancer and 8 vs 6 for pancreatic cancer; P < .001). On multivariable analysis, patients undergoing surgery at NCCN-NCI and high-volume hospitals were more likely to have at least 15 lymph nodes evaluated compared with patients undergoing surgery at community hospitals and low-volume centers (P < .001 and P =.02, respectively).
  
  
  CONCLUSIONS
  Nodal examination is important for staging, adjuvant therapy decision making, and clinical trial stratification. Moreover, differences in nodal evaluation may contribute to improved long-term outcomes at NCCN-NCI centers and high-volume hospitals for patients with gastric and pancreatic cancer.
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, Illinois, USA. k-bilimoria@northwestern.edu
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wayne
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
mesh_terms: D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery