Colon cancer and low lymph node count: Who is to blame?

Objective: To identify the factors that contribute to the disparity in the number of lymph nodes examined for curative colon cancer resections. Design: Our prospectively accrued cancer registry was analyzed for all colon cancer resections performed in a consecutive 52-month period (January 1, 2003, through April 30, 2007). Setting: The study was performed at an 851-bed community hospital. Seventeen surgeons performed colon resections, with the number of resections varying from 1 to 154. Ten pathologists and 3 pathology assistants evaluated the specimens. Patients: A total of 430 patients met the inclusion criteria and underwent surgical resection. Only patients with colon cancer were included in the study; patients with rectal cancers, in situ disease only, T4 tumors, and stage IV disease at the time of diagnosis were excluded to ensure a uniform group of patients, all undergoing resection with curative intent. Main Outcome Measures: Age of the patient; the surgeon, pathologist, and pathology technician; stage of disease; and year of surgery were analyzed. Results: No statistical difference was found in the number of lymph nodes retrieved based on the surgeon (P=.21), pathologist (P=.11), or pathology technician (P=.26). Age of the patient, primary site of the tumor, stage, and year of surgery were all significantly associated with number of lymph nodes retrieved (P<.001). Conclusions: The origin of a low lymph node count appears multifactorial. Inadequate lymph node retrieval for colon cancer resections cannot uniformly be attributed to 1 factor, such as the surgeon.