Lymph Node Evaluation and Survival in Stage II and III Colon Cancer

Identifying indicators of quality in surgery has become an important aspect of surgical outcomes research. A number of national organizations have proposed a standard requiring a minimum of 12 lymph nodes removed and evaluated during colon cancer surgery as a quality measure. A systematic review of 17 studies including more than 60,000 patients evaluated survival outcomes in stage II and III colon cancer related to the extent of lymph node evaluation. The preponderance of evidence demonstrated an association between increased lymph node evaluation and improved survival. Surgeon and pathologist behavior can be modified to increase lymph node evaluation, however, the effect of educational intervention on survival will require further study. Although the optimal indicator of quality is still under debate and the association between lymph node recovery and survival is not completely understood, surgeons and pathologists should monitor and attempt to improve the extent of lymph node evaluation.