The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease

Evans, M. D.; Barton, Karen D.; Rees, Adam; Stamatakis, J. D.; Karandikar, Sharad

doi:10.1111/j.1463-1318.2007.01225.x

Cited by 105 publications

(105 citation statements)

References 32 publications

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“…Our results are in total agreement with similar recent studies suggesting that tumor location, tumor grade [13], stage [14][15][16] and size is significantly impacting the number of identifiable LNs [17]. Shen et al have recently reported that number of harvested LNs is most significantly associated with tumor location (right sided vs left sided cancer), patient age and length of resected specimen [12].…”

Section: Discussionsupporting

confidence: 83%

“…This was the most compelling factor when comparing the VAMC to KUMC. Several studies have suggested the potential impact of surgeons training and surgical techniques on lymph node harvesting [14,15,[19][20][21][22][23]. It has been known that surgeons with more training and/or experience in colorectal procedures were more successful in obtaining adequate resections.…”

Section: Discussionmentioning

confidence: 99%

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Variables Impacting Lymph Node Recovery in Colectomy Resection Specimens Removed for Colorectal Adenocarcinoma

Schafer¹,

Kimler

McGregor³

et al. 2013

TOPATJ

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Abstract:Background: Recent data suggest that a higher number of nodes evaluated in colectomy specimens for colorectal adenocarcinoma is associated with increased survival. Recommendations mandate the harvesting of at least 12 nodes in colectomy specimens for adequate assessment. Recent studies argue that the above association is complex and is uncontrolled for a variety of variables.Objective: The study's objective is to evaluate several factors that impact the harvesting of lymph nodes in colectomy specimen. Patients:We reviewed 306 colectomy specimens from 2 academic medical centers, 177 from Kansas University Medical Center (KUMC) and 129 from the Kansas City Veterans Affairs Medical Center (VAMC) from 2000 to 2007.Design: Factors evaluated included tumor size, grade, stage, site, number of positive nodes and length of colectomy segment removed. We compared the number of nodes removed at the 2 institutions and whether individual surgeons had an impact on the number of harvested nodes.Results: Harvesting at least 12 nodes is correlated with larger tumor size, higher grade and stage and specimens longer than 21 cm. More nodes were harvested from the right colon (mean=13 nodes), followed by descending (12 nodes), transverse and rectosigmoid (10 nodes each). Number of positive nodes correlated with tumor grade, but not with tumor site, size, linear length of specimen or whether 12 nodes were harvested.Cases from the VAMC were more likely to harvest 12 nodes compared to KUMC. It was noted that 2 of 10 surgeons at the VAMC performed 76% of all surgeries. There were 21 surgeons at KUMC; none performed more than 12% of the cases. Conclusion:Number of harvested nodes is related to other prognostically significant parameters primarily related to tumor biology. The potential impact of surgeon's experience and the type of surgery performed needs further evaluation.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Variables Impacting Lymph Node Recovery in Colectomy Resection Specimens Removed for Colorectal Adenocarcinoma

Schafer¹,

Kimler

McGregor³

et al. 2013

TOPATJ

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“…Those two modifiable factors have had inconsistent associations with ln yield in the literature [17][18][19][20][21][22][23][24] . Nevertheless, although variations in hospital-associated ln yield are larger than those for individual pathologists and surgeons, patient-related variations are largest 18 .…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Evaluation for Colon Cancer in Routine Clinical Practice: A Population-Based Study

et al. 2017

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“…An additional limitation is that adequacy of lymph node harvest can be affected by the reporting pathologist. 12 Our database did not distinguish among reporting pathologists, and adequacy of nodal harvest by pathologist was not available.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery

Patel

Brackstone

2014

Can J Surg

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Background: It has been suggested that inadequate lymph node harvest may result in pathologically understaged or indeterminate staging of patients with colorectal cancer (CRC). We compared the adequacy of nodal staging in patients undergoing emergency surgery compared with elective surgery for CRC.Methods: Using a prospectively collected CRC surgery database at a tertiary care centre, we performed a cohort study. The mean number of lymph nodes harvested and the proportion of patients who had inadequate staging (< 12 nodes harvested) were compared between emergency and elective surgery cohorts. Our analysis was adjusted for tumour site, type of resection, surgical training and pathologic stage.Results: A total of 1279 of 1356 (94%) enrolled patients had nodal data available for an aly sis; 161 (13%) patients had emergency surgery and 1118 (87%) had elective surgery. The mean number of nodes removed was higher in the emergency surgery group (mean difference +2.8, 95% confidence interval [CI] 0.6-5.1, p = 0.012). The proportion of patients with inadequate nodal staging did not differ between groups (emergent 16%, elective 17%, p = 0.79). The odds of adequate nodal staging, adjusting for site, type of resection, training and stage was no different between groups (OR 0.80, 95% CI 0.47-1.35, p = 0.41). Conclusion:The evidence does not support the common belief that emergency surgery is more commonly understaged in CRC. Our data suggest emergency surgery resulted in a significant increase in the average number of nodes harvested, with no difference in inadequate nodal staging.

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The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease

Abstract: Overall lymph node harvest, in this unit, varied according to the reporting pathologist but not operating surgeon. As lymph node harvest increased to 15 per patient, the probability of identifying a metastatic node increased.

Cited by 105 publications

References 32 publications

Variables Impacting Lymph Node Recovery in Colectomy Resection Specimens Removed for Colorectal Adenocarcinoma

Variables Impacting Lymph Node Recovery in Colectomy Resection Specimens Removed for Colorectal Adenocarcinoma

Lymph Node Evaluation for Colon Cancer in Routine Clinical Practice: A Population-Based Study

Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery

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