Multicentre review of lymph node harvest in colorectal cancer: are we understaging colorectal cancer patients?
BACKGROUND
Lymph node examination in colorectal cancer is of vital importance for accurate staging. Patients who have fewer nodes examined may be understaged and not offered adjuvant chemotherapy. The national institute of clinical excellence and the association of coloproctology of Great Britain and Ireland both recommend that 12 nodes should be examined for accurate staging. The aim of this study was to assess lymph node harvest at five hospitals in the northwest of England in respect to these guidelines.


METHODS
This study is a retrospective review of all colorectal cancer resections over a 1-year period at five hospitals.


RESULTS
Two hospitals met the national guidelines of a median of 12 or more nodes. Overall, over 50% of colorectal cancers contained fewer than 12 nodes. Fifty-three point seven percent (53.7%) of Dukes B patients did not have 12 nodes in their specimens and may therefore be understaged. There was a significant variation between hospitals in terms of the number of cancers with 12 or more nodes (P < 0.0001) and the number of Dukes B cancers with 12 or more nodes (P < 0.008).


CONCLUSIONS
Over 50% of all colorectal cancer specimens contain fewer than 12 lymph nodes despite clear national guidelines. This is of particular importance to Dukes B cancers where over 53% of cases may be understaged and not offered adjuvant therapy. Significant variation exists between hospitals within the same region.
Mitchell
P J
PJ
Department of General Surgery, University Hospital of South Manchester NHS Trust, Manchester, UK. peter.mitchell40@btopenworld.com
Ravi
S
S
Grifftiths
B
B
Reid
F
F
Speake
D
D
Midgley
C
C
Mapstone
N
N
D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D004739:England; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies