Author Affiliation: Department of Surgery, MD Anderson Cancer Center, University of Texas, Houston.
Quality improvement processes are most relevant when they establish or compare to validated benchmarks. Metrics such as survival,perioperative events, extent of resection, and local recurrence are often associated with the quality of esophagectomy. However, most of these outcomes are also correlated with a patient's disease burden and demographic characteristics. To the extent that it is extremely difficult to compare patient populations between hospitals, other indicators of surgical quality such as the number of lymph nodes resected may serve as a better surrogate. Evidence-based data support the removal of between 10 and 50 lymph nodes (pT1-pT4) during esophagectomy for cancer.1,2
Hofstetter WL. Lymphadenectomy as a Benchmark to Surgical Quality in EsophagectomyComment on “Variation in Lymph Node Examination After Esophagectomy for Cancer in the United States”. Arch Surg. 2012;147(6):511-512. doi:10.1001/archsurg.2012.271