Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance.
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.
Dillman
Robert O
RO
Hoag Cancer Center, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA. rdillman@hoaghospital.org
Aaron
Kenneth
K
Heinemann
F Scott
FS
McClure
Stephanie E
SE
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