Hospital-to-hospital variation in lymph node detection after colorectal resection

Better recovery of lymph nodes from colorectal carcinoma resection specimens has been shown to be associated with higher survival rates for patients with TNM Stage II and Stage III tumors. It is possible that inadequate lymph node recovery and/or assessment could contribute to disparities in survival, with particular variation according to hospital volume.

Data from a population-based study that involved 33 counties in North Carolina and was conducted between April 1997 and April 2000 were available for the examination of variations in lymph node recovery and detection of positive lymph nodes according to self-reported demographic characteristics and hospital volume. The study comprised 324 patients with T2-T3N0-N1M0 colon adenocarcinoma. Logistic regression was used to determine odds ratios (ORs) associated with the recovery of fewer than seven lymph nodes and ORs associated with the detection of a positive lymph node according to hospital volume and patient characteristics.

Low-volume hospitals were more likely to recover < 7 lymph nodes compared with high- and medium-volume hospitals (low-volume vs. high-volume: adjusted OR, 1.9; 95% confidence interval [CI], 0.8-4.6; low-volume vs. medium-volume: adjusted OR, 1.7; 95% CI, 0.7-4.5) and less likely to detect positive lymph nodes. After controlling for tumor characteristics, low-volume hospitals were less than one-half as likely to detect a positive lymph node (low-volume vs. high-volume: adjusted OR, 0.3; 95% CI, 0.1-0.8; low-volume vs. medium-volume: adjusted OR, 0.4; 95% CI, 0.1-1.2).

The current study suggests that patients at low-volume hospitals may have their tumors pathologically understaged more frequently compared with patients at high- and medium-volume hospitals.