title: The positive impact of surgical quality control on adequate lymph node harvest by standardized laparoscopic surgery and national quality assessment program in colorectal cancer.
abstract: OBJECTIVE
  We aimed to present the factors associated with lymph node harvest (LNH) and seek whether surgical quality control measures can improve LNH.
  
  
  METHODS
  From a prospectively collected data at a single institution, 874 CRC patients who underwent curative surgery between 2004 and 2013 were included. Factor and survival analyses were performed regarding LNH. Subgroup analysis was performed according to LNH group (LNH ≥ 12 vs LNH < 12) and year of surgery (2004-2008, 2009-2011, and 2012-2013 group).
  
  
  RESULTS
  In the multivariate analysis, tumor location (OR 0.6, p < 0.001), stage (OR 1.95, p < 0.001), and year of surgery (OR 3.86, p < 0.001) showed an association with adequate LNH. In the subgroup analysis categorized by the year of surgery, surgical quality control measures by standardized laparoscopic surgery (OR 52.91, p < 0.001) showed notable association with adequate LNH. Comparing the 2009-2011 and 2012-2013 group, the national quality assessment program additionally improved adequate LNH percentage (83.9 vs 94.3%). In the survival analysis, disease-free survival (DFS) differed according to year of surgery, standardized laparoscopic surgery with high vascular ligation, and adequate LNH by stage. In the overall survival (OS) analysis, the LNH-related factors did not show significant difference.
  
  
  CONCLUSIONS
  Through standardized laparoscopic surgery with high vascular ligation and national quality assessment program, surgical quality control had a positive impact on the increase of adequate LNH. Improving the modifiable LNH factors resulted in the enhancement of adequate LNH and related DFS.
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
authors.forename: Daeyoun David
authors.initials: DD
authors.lastname: Won
authors.affiliation: Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sung Bong
authors.initials: SB
authors.lastname: Choi
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Yoon Suk
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
authors.forename: Seong Taek
authors.initials: ST
authors.lastname: Oh
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
authors.forename: Jun Gi
authors.initials: JG
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. cmcgslee@catholic.ac.kr.
authors.forename: In Kyu
authors.initials: IK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011786:Quality Control; D012015:Reference Standards; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Colorectal cancer; Lymph node harvest; National quality assessment program; Standardized laparoscopic surgery; Surgical quality control