title: Lymph node retrieval in pancreaticoduodenectomy specimens: does educating the pathologist matter?
abstract: BACKGROUND
  Many previous studies have suggested that the number of lymph nodes retrieved should serve as a benchmark for assessing the adequacy of the resection. The aim was to retrospectively observe the impact of nodal retrieval after educating the pathologist.
  
  
  METHODS
  Patients undergoing a pancreaticoduodenectomy (PD) between September 2005 and March 2009 were included in the study. The PDs performed between September 2005 and March 2008 were designated as Group A. The pathologists were educated regarding the importance of nodal counts in PD by the surgeon on the 1st April 2008. PDs performed between April 2008 and March 2009 were designated as Group B.
  
  
  RESULTS
  Ninety-eight PDs performed by a single surgeon (D.R.J.) for peri-ampullary malignancy were evaluated. The median number of lymph nodes retrieved in Group A was 11(3-32) nodes. The median number of lymph nodes retrieved in Group B was 22 (10-29) nodes (P < 0.001).The lymph node ratio (positive/total nodes), median number of positive nodes retrieved, and the node positivity (node positive compared to node negative) rate did not change.
  
  
  CONCLUSIONS
  A single intervention with the pathologists did impact the number of lymph nodes retrieved from PD specimens. However, the lymph node ratio and lymph node positivity rate remained unchanged. The pathologist is critical to nodal retrieval in PD, but the use of this lymph node number for benchmark of surgical adequacy may be simplistic.
authors.affiliation: Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; Department of Hepatopancreatobiliary Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; Department of Cancer Center, Methodist Dallas Medical Center, Dallas, TX, USA.
authors.forename: D Rohan
authors.initials: DR
authors.lastname: Jeyarajah
authors.forename: Amit
authors.initials: A
authors.lastname: Khithani
authors.forename: Veeraiah
authors.initials: V
authors.lastname: Siripurapu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Liu
authors.forename: Ashley
authors.initials: A
authors.lastname: Thomas
authors.forename: A Joe
authors.initials: AJ
authors.lastname: Saad
mesh_terms: D019985:Benchmarking; D004502:Education, Medical, Continuing; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000592:standards; D010336:Pathology / Q000193:education* / Q000592:standards; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome