Increased lymph node evaluation with colorectal cancer resection: does it improve detection of stage III disease?
OBJECTIVE
Evaluation of 12 or more lymph nodes (LNs) with colorectal cancer (CRC) resection may not improve detection of stage III disease.


METHODS
Retrospective review after intervention.


METHODS
Community teaching hospital.


METHODS
We evaluated 701 consecutive operative CRC cases ascertained from our Cancer Registry.


METHODS
Patients undergoing resection before (n = 553) a multidisciplinary initiative emphasizing the importance of LN counts were compared with those undergoing operation afterward (n = 148).


METHODS
Number of LNs evaluated, proportion of patients with stage III disease, and proportion of patients with N1 vs N2 disease.


RESULTS
Demographic, tumor, and treatment variables were similar for both groups, except for younger age, fewer white patients, and more laparoscopic resections in the late period. Lymph node counts increased from a mean (SEM [median]) of 12.8 (0.3 [12]) to 17.3 (0.7 [16]) (P < .001), with 53.0% of the early vs 71.6% of the late patients having at least 12 LNs examined. The proportion diagnosed as having stage III CRC was 204 of 553 (36.9%) for the early group vs 48 of 148 (32.4%) for the late group (P = .31). Among patients with positive LNs, the distribution of N1 and N2 disease was unchanged (early, 50.5% N1 and 49.5% N2; late, 54.2% N1 and 45.8% N2; P = .54).


CONCLUSIONS
Increased LN retrieval does not identify a greater number of patients with stage III CRC nor does it increase the proportion of patients with positive LNs with N2 disease. Our data suggest that harvest of at least 12 LNs as a quality or performance measure appears unfounded.
Kukreja
Sachin S
SS
Department of Surgery, Rush North Shore Medical Center, Skokie, IL 60076, USA.
Esteban-Agusti
Enrique
E
Velasco
Josè M
JM
Hieken
Tina J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000592:standards; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011787:Quality of Health Care; D012042:Registries; D020858:Tissue and Organ Harvesting