P215: An audit of lymph node retrieval in colorectal cancer patients at a rural academic center

Abstract

Background: Both the American Joint Committee on Cancer and The International Union Against Cancer recommend a minimum of 12 lymph nodes to accurately stage a colorectal cancer patient. In a recent national review of 116995 colorectal cancer cases by Baxter et al (Journal of the National Cancer Institute 2005;97:219-225) only 37% received adequate lymph node sampling at the time of tumor resection. Given the alarming implications of these findings, we conducted a review of lymph node retrieval in our own colorectal cancer cases. Methods: A retrospective review of newly diagnosed colorectal cancer cases from 2003 to mid-2004 was performed. Of the 80 cases identified, 64 were found eligible for review, 14 did not have surgical resection and 2 had neoadjuvant therapy. Results: Adequate nodal resection was achieved in 69% of patients. The median number of lymph nodes sampled was 17 (mean = 20). Factors associated with sub-optimal lymph node retrieval was laparoscopic resection and gross pathology performed by the attending rather than the physicians assistant. Conclusions: Lymph node status is a strong predictor of outcome in colorectal cancer with regard to overall survival and recurrence rate. In order to recommend appropriate treatment, adequate nodal sampling is required to accurately stage colorectal cancer patients. Although our rate of sufficient nodal sampling is better than that reported for the national population, this still leaves a large proportion of our patients potentially not being staged properly. The number of nodes retrieved during colon resection for cancer needs to be examined by individual institutions.