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Updated: Jun 7, 2025
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital?
Muhammad Musaab Munir1, Selamawit Woldesenbet1, Mujtaba Khalil1
1Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Background:
We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.
Methods:
SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).
Results:
2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 %). After accounting for all explanatory variables in the full model, 5.5 % of the residual provider-level variation was attributed to the pathologist, 35.2 % to the surgeon, and 59.3 % to the hospital.
Conclusions:
Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.
