title: Variation in lymph node examination after esophagectomy for cancer in the United States.
abstract: OBJECTIVE
  To evaluate the quality of lymph node examination after esophagectomy for cancer in the United States based on current treatment guidelines (15 nodes) and to assess the association of patient, tumor, and hospital factors with the adequacy of lymph node examination.
  
  
  METHODS
  Retrospective observational study from 1998 to 2007.
  
  
  METHODS
  National cancer database.
  
  
  METHODS
  Patients with stage I through III esophageal cancer undergoing esophagectomy and not treated with neoadjuvant chemoradiotherapy.
  
  
  METHODS
  Rate of adequate lymph node examination (15 nodes).
  
  
  RESULTS
  A total of 13 995 patients were identified from 639 hospitals. Overall, 4014 patients (28.7%) had at least 15 lymph nodes examined, which increased from 23.5% to 34.4% during the study period. At the hospital level, only 45 centers (7.0%) examined a median of at least 15 lymph nodes. In the most recent period (2005-2007), at least 15 nodes were examined in 38.9% of patients at academic centers vs 28.0% at community hospitals and in 44.1% at high-volume centers vs 29.3% at low-volume centers. On multivariable analysis, hospital type, surgical volume status, and geographic location remained significant predictors of having at least 15 lymph nodes examined.
  
  
  CONCLUSIONS
  Fewer than one-third of patients and fewer than 1 in 10 hospitals met the benchmark of examining at least 15 lymph nodes. Hospitals should perform internal process improvement activities to improve guideline adherence.
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Merkow
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Warren B
authors.initials: WB
authors.lastname: Chow
authors.forename: Justin S
authors.initials: JS
authors.lastname: Merkow
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weyant
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
mesh_terms: D000368:Aged; D019985:Benchmarking; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000706:statistics & numerical data; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012189:Retrospective Studies; D014481:United States