Evaluation of a policy of lymph node retrieval for colon cancer specimens: a quality improvement opportunity

Background In an effort to improve compliance with the national guidelines of adequate lymph node harvest for colon cancer, the Department of Pathology at the Valley Health System in Paramus, New Jersey, established a policy in 2011 stating that if fewer than 12 lymph nodes were evaluated after initial dissection of a non-metastatic invasive colon cancer specimen, then re-dissection of the specimen was performed to harvest additional lymph nodes.

 

Objective To evaluate the efficacy of the policy as it relates to the compliance for sufficient lymph node evaluation in non-metastatic invasive colon cancers.

 

Methods A review of the Valley Hospital Health System Tumor Registry for all adult patients who had undergone surgery for stages I-III colon adenocarcinoma during January 1, 2007-July 1, 2015 identified 626 patients. The patients were divided into 2 groups, pre-policy (n = 301) and post-policy (n = 325), for analysis.

 

Results The median lymph node yield in the post-policy group increased significantly and the percentage of inadequate lymph node evaluation significantly decreased, compared with the pre-policy group. With the improvement of lymph node yields, fewer patients received chemotherapy for stage II colon cancer. Overall survival of patients with adequate lymph node yields was significantly longer than in patients with inadequate yields.

 

Limitations Single institutional study with relatively small numbers.

 

Conclusions The results of this study suggest that the implementation of a policy of reflexive re-dissection for colon cancer specimens with inadequate lymph node yields decreases the number of insufficient lymph node specimens and significantly improves compliance with national guidelines.

 

 

 

 

 

 

 

Background In an effort to improve compliance with the national guidelines of adequate lymph node harvest for colon cancer, the Department of Pathology at the Valley Health System in Paramus, New Jersey, established a policy in 2011 stating that if fewer than 12 lymph nodes were evaluated after initial dissection of a non-metastatic invasive colon cancer specimen, then re-dissection of the specimen was performed to harvest additional lymph nodes.

 

Objective To evaluate the efficacy of the policy as it relates to the compliance for sufficient lymph node evaluation in non-metastatic invasive colon cancers.

 

Methods A review of the Valley Hospital Health System Tumor Registry for all adult patients who had undergone surgery for stages I-III colon adenocarcinoma during January 1, 2007-July 1, 2015 identified 626 patients. The patients were divided into 2 groups, pre-policy (n = 301) and post-policy (n = 325), for analysis.

 

Results The median lymph node yield in the post-policy group increased significantly and the percentage of inadequate lymph node evaluation significantly decreased, compared with the pre-policy group. With the improvement of lymph node yields, fewer patients received chemotherapy for stage II colon cancer. Overall survival of patients with adequate lymph node yields was significantly longer than in patients with inadequate yields.

 

Limitations Single institutional study with relatively small numbers.

 

Conclusions The results of this study suggest that the implementation of a policy of reflexive re-dissection for colon cancer specimens with inadequate lymph node yields decreases the number of insufficient lymph node specimens and significantly improves compliance with national guidelines.

 

 

 

 

 

 

 

Background In an effort to improve compliance with the national guidelines of adequate lymph node harvest for colon cancer, the Department of Pathology at the Valley Health System in Paramus, New Jersey, established a policy in 2011 stating that if fewer than 12 lymph nodes were evaluated after initial dissection of a non-metastatic invasive colon cancer specimen, then re-dissection of the specimen was performed to harvest additional lymph nodes.

 

Objective To evaluate the efficacy of the policy as it relates to the compliance for sufficient lymph node evaluation in non-metastatic invasive colon cancers.

 

Methods A review of the Valley Hospital Health System Tumor Registry for all adult patients who had undergone surgery for stages I-III colon adenocarcinoma during January 1, 2007-July 1, 2015 identified 626 patients. The patients were divided into 2 groups, pre-policy (n = 301) and post-policy (n = 325), for analysis.

 

Results The median lymph node yield in the post-policy group increased significantly and the percentage of inadequate lymph node evaluation significantly decreased, compared with the pre-policy group. With the improvement of lymph node yields, fewer patients received chemotherapy for stage II colon cancer. Overall survival of patients with adequate lymph node yields was significantly longer than in patients with inadequate yields.

 

Limitations Single institutional study with relatively small numbers.

 

Conclusions The results of this study suggest that the implementation of a policy of reflexive re-dissection for colon cancer specimens with inadequate lymph node yields decreases the number of insufficient lymph node specimens and significantly improves compliance with national guidelines.