Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance

BACKGROUND: Identification of ≥12 lymph nodes in resected colon cancer specimens has been endorsed as a quality indicator. METHODS: The Hoag Hospital cancer registry was used to identify patients diagnosed with colon cancer. The proportion of colon cancer specimens for which ≥12 lymph nodes were identified was determined by anatomic location, stage of disease, patient age, and operating surgeon. Survival was correlated with stage and with whether ≥12 lymph nodes were identified. RESULTS: Pathology procedural changes in 1998 were associated with an increase in the average number of lymph nodes identified from 8.0 to 14.5 ( P < .0001); therefore, analysis was limited to 574 patients who underwent surgical resection of colon adenocarcinoma during 1998 to 2005. Identification of ≥12 lymph nodes varied from 57% to 83% by 7 anatomic locations ( P < .0001), from 65% to 75% by 5 age cohorts ( P = .027), from 59% to 73% by 4 general stages of disease ( P = .004), and from 53% to 80% among 12 surgeons who performed at least 17 resections ( P = .014). The proportion of resections in which ≥12 lymph nodes were identified was higher for 3 colorectal fellowship‐trained surgeons compared with the other 9 surgeons (77% vs 63%, P = .0007), and with 30 surgeons who each performed <10 resections (77% vs 51%, P < .0001). Identification of ≥12 lymph nodes was associated with better survival for patients with stage I ( P = .016) and stage II ( P = .021) disease. CONCLUSIONS: Anatomic location, colorectal surgical training, and case volume were strongly correlated with the number of lymph nodes identified. Cancer 2009. © 2009 American Cancer Society.