A National Study on Lymph Node Retrieval in Resectional Surgery for Colorectal Cancer |
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Authors: | Paris P Tekkis MD FRCS Jason J Smith FRCS Alexander G Heriot FRCS Ara W Darzi FRCS Michael R Thompson FRCS Jeffrey D Stamatakis FRCS |
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Institution: | (1) Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary’s Hospital, London, United Kingdom;(2) Department of Surgical Oncology and Technology, Imperial College London, St. Mary’s Hospital, 10th Floor, QEQM Wing, Praed Street, London, W2 1NY, United Kingdom;(3) Department of Surgery, West Middlesex Hospital, Isleworth, United Kingdom;(4) Department of Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom;(5) Department of Surgery, Princess of Wales Hospital, Bridgend, United Kingdom |
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Abstract: | Purpose This study was designed to develop a mathematical model for predicting the number of lymph nodes harvested in bowel cancer
resection specimens based on the current clinical practice in the United Kingdom.
Methods Prospective clinical data were collected from 8,409 newly diagnosed bowel cancer patients presenting to 79 hospitals in Great
Britain and Ireland during a variable 12-month period from 2000 to 2002. A two-level hierarchical regression model was used
to identify predictors for lymph node harvest. The model was internally validated by comparing observed and model predicted
lymph node harvest for patient subgroups.
Results Inclusion criteria were satisfied by 5,164 patients. The average lymph node harvest was 11.7 nodes with significant between-center
variability in lymph node harvest (range, 5.5–21.3 nodes). Increasing age, American Society of Anesthesiology grade, and preoperative
radiotherapy were associated with a reduction of lymph node harvest (P < 0.001). Abdominoperineal resection of the rectum and transverse colectomy were the lowest yield procedures for lymph node
harvest. Independent predictors of lymph node harvest were age, American Society of Anesthesiology grade, Dukes stage, operative
urgency, type of resection, and preoperative radiotherapy. When tested, the model was found to accurately predict lymph node
harvest for group statistics (comparison of observed and model predicted lymph node harvest F1,5154 = 0.63; P = 0.427).
Conclusions The results of the study suggest that the minimum number of lymph nodes harvested in colorectal cancer surgery cannot be set
at a fixed value. The lymph node harvest model provides a simple tool to the frontline clinician for comparing standards between
multidisciplinary bowel cancer teams.
Supported by the National Clinical Audit Support Programme, (NCASP), United Kingdom. |
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Keywords: | Colorectal cancer Lymph node metastases Risk adjustment Quality |
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