Lymph Node Retrieval and Assessment after Colorectal Cancer Resection: Are Pathologists Doing an Adequate Job?
PURPOSE: Retrieval of the appropriate number of lymph nodes is important in staging colorectal cancer. Inadequate retrieval may result in understaging and inappropriate treatment. This study aimed to examine node retrieval and assessment in colorectal cancer resections performed by a single colorectal surgeon at two different institutions. METHODS: From 2000 to 2005, in a single colorectal surgeon's practice, 123 consecutive patients were identified who were undergoing open colectomies or proctectomies for colorectal cancer. Patients' demographic and surgical data were extracted from records for analysis. RESULTS: Forty patients underwent operations at Hospital A and 83 at Hospital B. No statistical difference in specimen length, tumor size, or stage was found between institutions. For colectomy and proctectomy specimens, Hospital A identified 9.6 and 6.1 nodes and Hospital B, 14.5 and 15 nodes, respectively. Significantly more nodes were identified at Hospital B (P < .001) particularly for proctectomy specimens (P < .001). Only 23 percent of colectomy and 7 percent of proctectomy specimens at Hospital A met American Joint Committee On Cancer guidelines of 12 or more nodes examined, whereas at Hospital B, 63 percent of each specimen type met guidelines (P < 0.05). CONCLUSIONS: Assessment of nodes varied significantly between institutions, which could lead to inadequate treatment. Lymph node retrieval efficiency should be known, and more successful techniques should be standardized.
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