Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer.
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.
Bilimoria
Karl Y
KY
Cancer Programs, American College of Surgeons, Chicago, Illinois, USA. k-bilimoria@northwestern.edu
Talamonti
Mark S
MS
Wayne
Jeffrey D
JD
Tomlinson
James S
JS
Stewart
Andrew K
AK
Winchester
David P
DP
Ko
Clifford Y
CY
Bentrem
David J
DJ
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