The influence of surgeon and pathologist in obtaining high median lymph node yields after colorectal resection for adenocarcinoma

Abstract

Aims: The number of lymph nodes evaluated after surgical resection for colorectal adenocarcinoma is positively associated with patient survival and is therefore used as a marker of quality in colon cancer care [1]. The aim of this study was to assess whether the individual surgeons and pathologists retrieving and analysing colorectal resection specimens at our centre differed in their lymph node yields (LNY). Methods: Casenotes for all elective Right Hemicolectomies (RHC) and Anterior Resections (AR) performed at our centre for adenocarcinoma between 2008 and 2009 were identified using hospital coding. Electronically archived histology reports were assessed for LNYs. Total and positive LNYs were compared between surgeons and pathologists using GnuPSPP statistical software. Results: Two dedicated colorectal surgeons and five pathologists produced 77 RHC and 125 AR [of which 62 were Total Mesorectal Excisions (TME)] specimens. Median total LNYs for each of our surgeons were similar (Table 1). Positive LNYs from RHC (P = 0.5), AR (P = 0.80) and TME (P = 0.23) were also similar between the surgeons. Of the five pathologists the median total LNYs for RHC, AR and TME specimens are shown in Table 1. The pathologist with the lowest LNY after TME had siginifantly more specimens (57%) treated with neoadjuvant radiotherapy than the other pathologists (P = 0.01). Comparison of positive LNYs between pathologists showed no differences (P = 0.05, P = 0.80 and P = 0.23 respectively). Conclusion: Lymph node yields following colorectal resection at our centre are far higher than published yields from other centres [2]. Whilst no difference was seen in the LNYs delivered by the two surgeons studied however there was a significant difference in total LNYs between our five pathologists; with some pathologists consistently producing huge yields. This did not, however, translate to a difference in positive LNYs produced by our pathologists although our study is underpowered to demonstrate equivalence. (Table presented).