Same Surgeon: Different Centre Equals Differing Lymph Node Harvest following Colorectal Cancer Resection

Area of Science:

• Oncology
• Surgical Pathology
• Gastroenterology

Background:

• Lymph node (LN) retrieval is crucial for accurate colorectal cancer (CRC) staging.
• Variations in LN yield can affect treatment decisions and prognostic accuracy.
• Assessing surgical quality often relies on metrics like LN harvest.

Purpose of the Study:

• To investigate the influence of surgeon relocation on lymph node retrieval in colorectal cancer resections.
• To compare lymph node yields and case mix before and after a surgeon moved between two hospital units.
• To identify factors affecting lymph node harvest in colorectal cancer surgery.

Main Methods:

• Retrospective analysis of 213 consecutive colorectal cancer resections performed by a single surgeon across two units.
• Comparison of median lymph node harvests and lymph node positivity rates between unit one (2002-2005) and unit two (2005-2009).
• Multivariate analysis to determine independent predictors of lymph node harvest.

Main Results:

• Median lymph node harvest was significantly higher in unit two (22 nodes/patient) compared to unit one (13 nodes/patient) (P < .001).
• No significant difference in lymph node positivity rates (42% vs. 48%) or case mix was observed between the units.
• Multivariate analysis identified the hospital unit and the pathologist as independent predictors of lymph node yield.

Conclusions:

• Surgeon relocation can lead to significant variations in lymph node retrieval during colorectal cancer resection.
• While both units met national standards, lymph node yield appeared to be influenced by the pathologist.
• Lymph node harvest as a sole surrogate marker for surgical quality in colorectal cancer may be unreliable due to external factors.