title: Does specialized surgical training increase lymph node yield in colon cancer?
abstract: Most colon cancer resections do not meet the 12-lymph node minimum recommended in 2001 National Cancer Institute (NCI) panel guidelines. Previous reports suggest surgical training influences lymph node recovery. We hypothesized that recent trends show improved results for lymphadenectomy regardless of specialty. The cancer registry database at a large community hospital with an academic surgical oncology training program was queried to identify resections performed for colon cancer before (1995 to 2000) and after (2001 to 2006) NCI guideline publication. There were no changes in pathology procedures between 374 early and 411 later procedures. The later period brought increases in mean total lymph nodes (15.4 vs 10.4, P < 0.0001), total positive nodes (1.8 vs 1.2, P = 0.005), and the percentage of procedures yielding 12 or more nodes (overall: 65.9 vs 36.0%, P < 0.0001; Stage II and III disease: 73.0 vs 41.4%, P < 0.003). In addition, mean nodal yield increased (P < 0.0001) for fellowship-trained surgeons (16.7 vs 11.2) and nonfellowship-trained surgeons (14.9 vs 10.2). Single-registry data show that since 2001, most colon resections exceed minimum recommendations for lymph node recovery regardless of surgical training. The increased rate of adequate lymphadenectomy for Stage II and III disease is encouraging because this patient population will benefit most by accurate staging of colon cancer.
authors.affiliation: John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA. nichollm@jwci.org
authors.forename: Michael B
authors.initials: MB
authors.lastname: Nicholl
authors.forename: Byron E
authors.initials: BE
authors.lastname: Wright
authors.forename: W Charles
authors.initials: WC
authors.lastname: Conway
authors.forename: Trista
authors.initials: T
authors.lastname: Aarnes-Leong
authors.forename: Myung-Shin
authors.initials: MS
authors.lastname: Sim
authors.forename: Mark B
authors.initials: MB
authors.lastname: Faries
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D003082:Colectomy / Q000193:education; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education*; D005257:Fellowships and Scholarships; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000193:education*; D008495:Medical Oncology / Q000193:education*; D009367:Neoplasm Staging; D012189:Retrospective Studies