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November 14, 2007

Lymph Node Counts in Colon Cancer Surgery: Lessons for Users of Quality Indicators

Author Affiliations

Author Affiliations: Department of Surgery, Hamilton Health Sciences, and Departments of Surgery, Oncology, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (Dr Simunovic); and Department of Surgery and Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (Dr Baxter).

JAMA. 2007;298(18):2194-2195. doi:10.1001/jama.298.18.2194

For patients undergoing curative colon cancer surgery, the presence of positive lymph nodes predicts a greater risk of disease recurrence than negative lymph nodes. Numerous studies have reported that for patients with negative nodes, survival is worse when relatively few lymph nodes are evaluated.1 Most reports suggest this is due to understaging (ie, positive lymph nodes are missed as a result of poor surgical or pathological practices) and consequently patients are falsely identified as having negative nodes. These incorrectly staged patients have a survival risk commensurate with their true node-positive status; additionally, such patients are less likely to receive (and potentially benefit from) chemotherapy. In the hope of improving patient outcomes, several stakeholder groups have identified the evaluation of 12 or more lymph nodes following colon cancer resection as an indicator of the quality of practice provided by individual surgeons or pathologists, hospitals, or regions.2 Due to concerns of understaging, the American Society of Clinical Oncology even encourages the use of chemotherapy for patients with nonmetastatic node-negative tumors in the presence of low lymph node counts.3