title: Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance.
abstract: BACKGROUND
  : Identification of > or =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 > or =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 > or =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 > or =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 > or =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 > or =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. (c) 2009 American Cancer Society.
authors.affiliation: Hoag Cancer Center, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA. rdillman@hoaghospital.org
authors.forename: Robert O
authors.initials: RO
authors.lastname: Dillman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Aaron
authors.forename: F Scott
authors.initials: FS
authors.lastname: Heinemann
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: McClure
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013502:General Surgery; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries