Identifying Outlier Hospitals in Gastric Cancer Lymph Node Yield Using the National Cancer Database

Area of Science:

• Oncology
• Surgical Pathology
• Health Services Research

Background:

• Lymph node (LN) yield is a critical quality metric for accurate staging in gastric cancer surgery.
• The National Comprehensive Cancer Network (NCCN) recommends a minimum of 15 LNs for proper staging.
• Many US facilities do not consistently achieve the recommended LN yield.

Purpose of the Study:

• To identify factors influencing lymph node yield at the facility level.
• To identify outlier hospitals with unusually high or low lymph node yields.
• To compare characteristics of high-performing versus low-performing hospitals regarding LN yield.

Main Methods:

• Retrospective review of adult patients (≥18 years) with Stages I-III gastric cancer who underwent gastrectomy.
• Analysis of data from the National Cancer Database (2004-2016).
• Multivariate analysis for patient/tumor characteristics and observed-to-expected ratios for outlier hospitals; comparison of facility factors between high and low outliers.

Main Results:

• 50.3% of 26,590 patients achieved the recommended ≥15 LN yield.
• 1245 facilities were analyzed, with 198 low and 135 high LN yield outliers identified.
• High LN yield hospitals had significantly greater yearly surgical volume (median 8.4 vs. 3.5) and were more likely to be academic facilities compared to low LN yield hospitals.

Conclusions:

• Suboptimal lymph node yield is prevalent, with nearly half of patients not meeting NCCN guidelines.
• Significant facility-level disparities in LN yield exist.
• Higher surgical volume and academic status are associated with superior lymph node retrieval in gastric cancer surgery.