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Original Article
December 21, 2009

Colon Cancer and Low Lymph Node Count: Who Is to Blame?

Author Affiliations

Author Affiliations: Department of Surgical Oncology, Lakeland Regional Cancer Center (Dr Jakub) and Cancer Registry (Ms Tillman) and Department of Pathology (Dr Lariscy), Lakeland Regional Medical Center, Lakeland, Florida; and Department of Biostatistical Sciences, Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Mr Russell). Dr Jakub is now with the Department of Surgery, Mayo Clinic, Rochester, Minnesota.

Arch Surg. 2009;144(12):1115-1120. doi:10.1001/archsurg.2009.210

Objective  To identify the factors that contribute to the disparity in the number of lymph nodes examined for curative colon cancer resections.

Design  Our prospectively accrued cancer registry was analyzed for all colon cancer resections performed in a consecutive 52-month period (January 1, 2003, through April 30, 2007).

Setting  The study was performed at an 851-bed community hospital. Seventeen surgeons performed colon resections, with the number of resections varying from 1 to 154. Ten pathologists and 3 pathology assistants evaluated the specimens.

Patients  A total of 430 patients met the inclusion criteria and underwent surgical resection. Only patients with colon cancer were included in the study; patients with rectal cancers, in situ disease only, T4 tumors, and stage IV disease at the time of diagnosis were excluded to ensure a uniform group of patients, all undergoing resection with curative intent.

Main Outcome Measures  Age of the patient; the surgeon, pathologist, and pathology technician; stage of disease; and year of surgery were analyzed.

Results  No statistical difference was found in the number of lymph nodes retrieved based on the surgeon (P = .21), pathologist (P = .11), or pathology technician (P = .26). Age of the patient, primary site of the tumor, stage, and year of surgery were all significantly associated with number of lymph nodes retrieved (P <.001).

Conclusions  The origin of a low lymph node count appears multifactorial. Inadequate lymph node retrieval for colon cancer resections cannot uniformly be attributed to 1 factor, such as the surgeon.