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Colorectal Specialization Increases Lymph Node Yield: Evidence from a National Database

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Current guidelines recommend the evaluation of at least 12 lymph nodes (LNs) in the pathologic specimen following surgery for colorectal cancer (CRC). We sought to examine the role of colorectal specialization on nodal identification.

Methods

We conducted a retrospective cohort study using SEER-Medicare data to examine the association between colorectal specialization and LN identification following surgery for colon and rectal adenocarcinoma between 2001 and 2009. Our dataset included patients >65 years who underwent surgical resection for CRC. We excluded patients with rectal cancer who had received neoadjuvant therapy. The primary outcome measure was the number of LNs identified in the pathologic specimen following surgery for CRC. Multivariate analysis was used to identify the association between surgical specialization and LN identification in the pathologic specimen.

Results

In multivariate analysis, odds of an adequate lymphadenectomy following surgery with a colorectal specialist were 1.32 and 1.41 times greater for colon and rectal cancer, respectively, than following surgery by a general surgeon (p < 0.001). These odds increased to 1.36 and 1.58, respectively, when analysis was limited to board-certified colorectal surgeons. Hospital factors associated with ≥12 LNs identified included high-volume CRC surgery (colon OR 1.84, p < 0.001; rectal OR 1.78, p < 0.001) and NCI-designated Cancer Centers (colon OR 1.75, p < 0.001; rectal OR 1.64; p = 0.007).

Conclusions

Colorectal specialization and, in particular, board-certification in colorectal surgery, is significantly associated with increased LN identification following surgery for colon and rectal adenocarcinoma since the adoption of the 12-LN guideline in 2001.

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Author Contributions

Study concept and design: E.C.P. and S.S.; acquisition, analysis, and interpretation of data: all authors; drafting of manuscript: E.C.P. and A.N.J.; critical revision of manuscript for intellectual content: all authors; statistical analysis: E.C.P.

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Authors and Affiliations

  1. Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Arjun N. Jeganathan MD

  2. Division of Colon & Rectal Surgery, Department of General Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Skandan Shanmugan MD, Joshua I. S. Bleier MD, Glenn M. Hall MD & Emily C. Paulson MD

  3. Department of General Surgery, Philadelphia VA Medical Center, Philadelphia, PA, 19104, USA

    Emily C. Paulson MD

Authors
  1. Arjun N. Jeganathan MD
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  2. Skandan Shanmugan MD
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  3. Joshua I. S. Bleier MD
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  4. Glenn M. Hall MD
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  5. Emily C. Paulson MD
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Corresponding author

Correspondence to Arjun N. Jeganathan MD.

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Jeganathan, A.N., Shanmugan, S., Bleier, J.I.S. et al. Colorectal Specialization Increases Lymph Node Yield: Evidence from a National Database. Ann Surg Oncol 23, 2258–2265 (2016). https://doi.org/10.1245/s10434-016-5122-6

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  • DOI: https://doi.org/10.1245/s10434-016-5122-6

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