Increased Lymph Node Evaluation With Colorectal Cancer Resection

Kukreja, Sachin; Esteban-Agusti, Enrique; Velasco, Josè M.; Hieken, Tina J.

doi:10.1001/archsurg.2009.112

Cited by 31 publications

(24 citation statements)

References 39 publications

(66 reference statements)

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“…In this regard, for over 20 years the "magic number" [17] 12 has always been considered the minimum number of lymph nodes to be sampled, which would allow for a correct diagnosis of "N0" in 90% of cases of colorectal cancer. However, this range is as a today considered "uncommon" or "not, adequate" or achievable only in specialized centers.…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer

Destri

Privitera

Greca

et al. 2016

International Surgery

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Abstract:Objective The authors seek to assess whether the LNR could predict the risk of metachronous liver metastases. Background data Using the goal of sampling 12 lymph nodes for a proper staging of colorectal cancer is often "uncommon" and the lymph node ratio (LNR) is what allows for a better prognosis selection of patients. Methods A homogeneous group of 280 patients, followed-up for at least 5 years, was evaluated. In order to highlight the groups with the highest risk of metachronous liver metastases, patients were divided into four quartiles groups in relation to the LNR. Results The number of lymph nodes sampled in group "stage I" was significantly lower. Even if statistical significance between the global LNR and the development of liver metastases has not been reached, the subdivision into quartiles has made it possible to highlight that in the more advanced ratio groups, a higher incidence of metachronous liver metastases (p <0.028) was registered and was a different distribution of patients with or without liver metastasis in function of quartiles (P =0.01).Conclusions The LNR has enabled us to prognosticate patients who are at greater risk of developing metachronous liver metastases. The lower lymph node sampling in the patients with less advanced staging (I) and in patients with node-negative cancer (I+II) who developed liver metastases, leads us to believe that some patients have been understaged. We believe that the LNR, especially in cases of adequate lymph node sampling, is a useful gauge to better sub-stratify "node-positive" patients. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationCover LetterClick here to access/download Cover Letter cover letter.pdf

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Section: Discussionmentioning

confidence: 99%

Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer

Destri

Privitera

Greca

et al. 2016

International Surgery

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“…For example, the proportion of patients with colorectal cancer undergoing surgery at community hospitals who had at least 12 lymph nodes examined increased from 53.0% from 1996 to 2004 to 71.6% from 2005 to 2007. 12 More broadly (ie, not only at community hospitals), the Agency for Healthcare Research and Quality 2010 National Healthcare Quality Report showed improvements over time for a number of cancer-related quality measures, including the proportion of adults receiving colorectal cancer screening, the proportion of adults diagnosed with colorectal cancer at regional or distant stages, and the proportion of patients with colorectal cancer undergoing surgical resection who had at least 12 lymph nodes examined. 13 Beyond the secular trends observed in quality-of-care improvements during this time period, use of the CoC RQRS also likely increased concordance with the quality measures of this evaluation.…”

Section: Discussionmentioning

confidence: 99%

Improving Quality of Cancer Care at Community Hospitals: Impact of the National Cancer Institute Community Cancer Centers Program Pilot

Halpern

Spain

Holden

et al. 2013

JOP

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Purpose: Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP. Methods:We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression.Results: Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparisongroup hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals. Conclusion: Both NCCCP and comparison-group hospitalsshowed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.

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“…Moreover, an increased number of evaluated nodes did not lead to better staging. A large study by Kukreja et al [18] has failed to demonstrate an increase in the proportion of stage III patients following an initiation of a program that increased significantly the number of patients with 12 or more evaluated nodes. They have concluded that harvesting of at least 12 nodes as a quality or performance measure appeared unfounded.…”

Section: Discussionmentioning

confidence: 99%

“…The adequacy of a lower threshold of evaluated nodes may reflect the fact that further examination of the specimen for lymph nodes following an adequate surgery would focus on smaller mesenteric nodes located away from the primary tumor that are less likely to contain disease [18].…”

Section: Discussionmentioning

confidence: 99%