“Fewer than one-third of patients and fewer than 1 in 10 hospitals met the benchmark of examining at least 15 lymph nodes” following esophagectomy for patients with esophageal cancer, according to a retrospective observational study reported in the Archives of Surgery. That benchmark was set by the National Comprehensive Cancer Network,” the authors noted.
Using the National Cancer Data Base, researchers identified 13,995 patients with stage I through III esophageal cancer undergoing esophagectomy at a total of 639 hospitals and not treated with neoadjuvant chemoradiotherapy. “Overall, 4,014 patients (28.7%) had at least 15 lymph nodes examined, which increased from 23.5% to 34.4% during the study period, [1998–2007],” the researchers reported.
Other Major Findings
“At the hospital level, only 45 centers (7.0%) examined a median of at least 15 lymph nodes. In the most recent period (2005–2007), at least 15 nodes were examined in 38.9% of patients at academic centers vs 28.0% at community hospitals and in 44.1% at high-volume centers vs 29.3% at low-volume centers. On multivariable analysis, hospital type, surgical volume status, and geographic location remained significant predictors of having at least 15 lymph nodes examined.” Patients in the Northeast were more likely to have at least 15 lymph nodes examined. “After controlling for confounding factors, compared with the Northeast, the South and Midwest were both 32% less likely to examine 15 nodes,” the investigators noted.
The authors concluded that hospitals “should perform internal process improvement activities to improve guideline adherence.” ■
Merkow RP, et al: Arch Surg 147:505-511, 2012.