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February 27, 2008

Lymph Node Examination Rate, Survival Rate, and Quality of Care in Colon Cancer

JAMA. 2008;299(8):896-898. doi:10.1001/jama.299.8.896-b

To the Editor: In the study of hospital lymph node examination rates by Dr Wong and colleagues,1 it was suggested that the number of lymph nodes examined is not relevant as a hospital quality indicator, whereas on the patient level the number of analyzed lymph nodes remains an important tool to assess outcome. We believe that this seemingly discrepant result can be explained by focusing on patients with N0 status. This retrospective study used the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database and included patients aged 65 years or older with colon cancer undergoing colectomy. Patient survival was assessed and categorized according to hospital performance based on the proportion of patients in whom at least 12 lymph nodes were examined. The survival analyses showed that the examination of more than 12 lymph nodes was not associated with improved survival. This is in contrast with previous studies and with many international guidelines for staging of patients.2 These results would suggest that the effort to find more lymph nodes is unnecessary. We believe the discrepancies are the result of patient selection.