Journal of Gastrointestinal Surgery

, Volume 13, Issue 8, pp 1459–1463 | Cite as

Colorectal Surgical Specimen Lymph Node Harvest: Improvement of Lymph Node Yield with a Pathology Assistant

  • Jeffery A. Reese
  • Christopher Hall
  • Kelly Bowles
  • Robert C. Moesinger
2008 SSAT Poster Presentation Manuscript

Abstract

Introduction

Adequate lymph node harvest from colorectal cancer specimens has become a standard of care, influencing both staging and survival. To improve lymph node harvests at our hospital, a pathology assistant was trained to meticulously harvest lymph nodes from colorectal cancer specimens. An analysis of trends in lymph node harvests over time is presented.

Methods

The number of harvested lymph nodes from 391 consecutive colorectal cancer pathology reports was retrospectively reviewed from a single community hospital over 8 years (1999–2006). This spanned 4 years prior to the training of the pathology assistant and 4 years after.

Results

From 1999–2002, the mean number of harvested lymph nodes varied from 12.2 to 14.4. The percentage of specimens achieving 12 lymph nodes was 50–67%. From 2003–2006, the mean number of harvested lymph nodes increased to 18.4–20.7, while the percentage of specimens achieving 12 lymph nodes was 83–87%. Both of these improvements achieved statistical significance with p values of <0.00001.

Conclusions

Over time, lymph node harvests at our hospital dramatically improved. The training of a pathology assistant to harvest the lymph nodes from colorectal cancer specimens dramatically affected lymph node harvests and can be a crucial component of pathologic analysis of these specimens.

Keywords

Colorectal neoplasms Lymph node excision Pathology Surgical 

References

  1. 1.
    Compton CC, Fielding LP, Burgardt LJ, et al. Prognostic factors in colorectal cancer. College of American Pathologists consensus statement. Arch Pathol Lab Med 2000;124:979–994.PubMedGoogle Scholar
  2. 2.
    Bilimoria KY, Stewart AK, Palis BE, Bentrem DJ, Talamonti MS, Ko CY. Adequacy and importance of lymph node evaluation for colon cancer in the elderly. J ACS 2008;206(2):247–254.Google Scholar
  3. 3.
    Evans MD, Barton K, Rees A, Stamatakis JD, Karandikar SS. The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease. Colorectal Dis 2008;10(2):157–164.PubMedGoogle Scholar
  4. 4.
    Kim J, Huynh R, Abraham I, Kim E, Kumar RR. Number of lymph nodes examined and its impact on colorectal cancer staging. Am Surg 2006;72(10):902–905.PubMedGoogle Scholar
  5. 5.
    Johnson PM, Porter GA, Ricciardi R, Baxter NN. Increasing negative lymph node count is independently associated with improved long term survival in stage IIIB and IIIC colon cancer. J Clin Oncol 2006;24:3570–3575. doi: 10.1200/JCO.2006.06.8866.CrossRefPubMedGoogle Scholar
  6. 6.
    Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: A secondary survey of Intergroup Trial INT-0089. J Clin Oncol 2003;21(15):2912–2919. doi: 10.1200/JCO.2003.05.062.CrossRefPubMedGoogle Scholar
  7. 7.
    Lincourt AE, Sing RF, Kercher KW, Stewart A, Demeter BL, Hope WW, Greene, Heniford BT, et al. Association of demographic and treatment variables in long-term colon cancer survival. Surg Innov 2008;15(1):17–25. doi: 10.1177/1553350608315955.CrossRefPubMedGoogle Scholar
  8. 8.
    Chen SL, Bilchik AJ. More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 2006;244(4):602–610.PubMedGoogle Scholar
  9. 9.
    Ricciardi R, Baxter NN. Association versus causation versus quality improvement: Setting benchmarks for lymph node evaluation in colon cancer. J Natl Cancer Inst 2007;99(6):414–415. doi: 10.1093/jnci/djk106.CrossRefPubMedGoogle Scholar
  10. 10.
    Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005;23(34):8706–8712. doi: 10.1200/JCO.2005.02.8852.CrossRefPubMedGoogle Scholar
  11. 11.
    Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O, Birkmeyer JD. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 2007;298(18):2149–2154. doi: 10.1001/jama.298.18.2149.CrossRefPubMedGoogle Scholar
  12. 12.
    Practice NCCN. Guidelines in Oncology. Colon Cancer. V2.2008. NCCN website. www.nccn.org/professionals/physician_gls/PDF/colon.pdf. P.17. Accessed August 5, 2008.
  13. 13.
    National Quality Forum Endorsed Commission on Cancer Measures for Quality of Cancer Care for Breast and Colorectal Cancers. American College of Surgeons, Commission on Cancer Website. www.facs.org/cancer/qualitymeasures.html. Accessed August 9, 2008.
  14. 14.
    Ostadi MA, Harnish JL, Stegienko S, Urbach DR. Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens. Surg Endosc 2007;21(12):2142–2146. doi: 10.1007/s00464-007-9414-6.CrossRefPubMedGoogle Scholar
  15. 15.
    Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Viring BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 2005;97(3):219–225.PubMedCrossRefGoogle Scholar
  16. 16.
    Wright FC, Law CH, Last LD, Ritacco R, Kumar D, Hsieh E, et al. Barriers to optimal assessment of lymph nodes in colorectal cancer specimens. Am J Clin Pathol 2004;121(5):663–670. doi: 10.1309/17VKM33BFXF9T8WD.CrossRefPubMedGoogle Scholar
  17. 17.
    Utah QuickFacts from the US Census Bureau.  quickfacts.census.gov/qfd/states/49000.html. Accessed July 22, 2008.
  18. 18.
    Decal website. www.decal-bone.com/dissectaid.html. Accessed August 28, 2008.
  19. 19.
    Jass JR, O’Brien J, Riddell RH, Snover DC. Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of surgically resected specimens of colorectal carcinoma: Association of Directors of Anatomic and Surgical Pathology. Am J Clin Pathol 2008;129(1):13–23. doi: 10.1309/6UHNC7MAD8KWNAWC.CrossRefPubMedGoogle Scholar
  20. 20.
    Rajput A, Skibber J, Engstrom P, Weiser M, Wilson J, Shibata S, et al. D. Schrag for the NCCN Colon/Rectal Outcomes Project. Meeting the 12 lymph nodes (LN) benchmark in colorectal cancer surgery: A comparison of NCCN and SEER data. Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Vol 25, No 18S (June 20 Supplement), 2007. Abstract 4015.Google Scholar
  21. 21.
    Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: Recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 2002;26(2):179–189. doi: 10.1097/00000478–200202000–00004.CrossRefPubMedGoogle Scholar
  22. 22.
    Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW 3rd, Ko C, Moore R, Orsay C, et al. Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Practice parameters for colon cancer. Dis Colon Rectum 2004;47(8):1269–1284. doi: 10.1007/s10350–004–0598–8.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Jeffery A. Reese
    • 1
  • Christopher Hall
    • 2
  • Kelly Bowles
    • 2
  • Robert C. Moesinger
    • 3
    • 4
  1. 1.Department of RadiologyMcKay-Dee Hospital CenterOgdenUSA
  2. 2.Department of PathologyMcKay-Dee Hospital CenterOgdenUSA
  3. 3.Department of SurgeryMcKay-Dee Hospital CenterOgdenUSA
  4. 4.OgdenUSA

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