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Variation in Lymph Node Evaluation in Rectal Cancer: A Dutch Nationwide Population-Based Study

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

For adequate staging and subsequent accurate estimation of prognosis, a sufficient number of lymph nodes (LNs) has to be evaluated. This study aimed to identify factors associated with adequate nodal evaluation and to determine its relationship with survival.

Methods

Data from all patients with stage I to III rectal carcinoma who underwent surgical treatment and who were diagnosed in the period 2000 to 2006 were retrieved from the Netherlands Cancer Registry. Multilevel logistic analysis was performed to examine the influence of relevant factors on the number of evaluated LNs. Kaplan–Meier and Cox regression analyses were used to analyze the association with overall survival.

Results

The number of evaluated LNs was determined for 10,788 (91%) of 11,818 tumors. Median number of evaluated LNs was 7, ranging from 4 to 11 between pathology laboratories. The proportion of patients with positive LNs increased with increasing number of evaluated LNs. Men, younger patients, tumors with deeper invasion and nodal involvement, patients without preoperative radiotherapy who underwent a low anterior resection, and patients whose LNs were evaluated in an academic pathology laboratory were more likely to have ≥12 LNs evaluated. After adding these factors to the model, unexplained variation between pathology laboratories and between hospitals remained. The overall survival increased with increasing number of evaluated LNs.

Conclusions

A large variation in LN evaluation among patients with rectal cancer was revealed. Improvement in LN evaluation by both hospitals and pathology laboratories could improve staging, leading to more reliable estimation of prognosis.

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Acknowledgment

We thank the NCR for providing data from the cancer registry and Dr. R. Otter (Comprehensive Cancer Center North East) for her critical comments.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Research, Comprehensive Cancer Center North East, Groningen, The Netherlands

    M. A. G. Elferink MSc & S. Siesling PhD

  2. Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands

    S. Siesling PhD

  3. Department of Research, Comprehensive Cancer Center South, Eindhoven, The Netherlands

    V. E. P. P. Lemmens PhD

  4. Department of Public Health, Erasmus MC University, Rotterdam, The Netherlands

    V. E. P. P. Lemmens PhD

  5. Comprehensive Cancer Center Amsterdam, Amsterdam, The Netherlands

    O. Visser MD, PhD

  6. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    H. J. Rutten MD, PhD

  7. Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    J. H. J. M. van Krieken MD, PhD

  8. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    R. A. E. M. Tollenaar MD, PhD

  9. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    J. A. Langendijk MD, PhD

Authors
  1. M. A. G. Elferink MSc
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  2. S. Siesling PhD
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  3. V. E. P. P. Lemmens PhD
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  4. O. Visser MD, PhD
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  5. H. J. Rutten MD, PhD
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  6. J. H. J. M. van Krieken MD, PhD
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  7. R. A. E. M. Tollenaar MD, PhD
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Correspondence to M. A. G. Elferink MSc.

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Elferink, M.A.G., Siesling, S., Lemmens, V.E.P.P. et al. Variation in Lymph Node Evaluation in Rectal Cancer: A Dutch Nationwide Population-Based Study. Ann Surg Oncol 18, 386–395 (2011). https://doi.org/10.1245/s10434-010-1269-8

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  • DOI: https://doi.org/10.1245/s10434-010-1269-8

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