High-volume hospitals and comprehensive cancer centers examined more lymph nodes in gastric, pancreatic cancer

Patients who undergo surgery at National Comprehensive Cancer Network or National Cancer Institute hospitals had more lymph nodes evaluated than those undergoing surgery at low-volume centers.

Researchers from the American College of Surgeons in Chicago and other sites in California conducted a multivariable logistic regression analysis to determine the relationship between hospital type and nodal evaluation. The researchers identified 3,088 patients who underwent resection for gastric cancer and 1,130 for pancreatic cancer using the National Cancer Data Base.

In the United States, 23.2% of patients with gastric cancer and 16.4% of patients with pancreatic cancer underwent evaluation of at least 15 lymph nodes — the currently recommended number — according to the researchers.

Compared with community hospitals, more lymph nodes were examined at NCCN-NCI hospitals in both gastric (12 vs. 6) and pancreatic cancer (9 vs. 6; P<.001 for both).

Patients with both gastric and pancreatic cancer had more nodes examined at highest-volume hospitals than low-volume hospitals (10 vs. 6 for gastric and 8 vs. 6 for pancreatic; P<.001).

The researchers concluded that “further investigation is needed to identify the reasons for better lymph node examination rates at NCCN-NCI centers and high-volume hospitals and to transfer those processes to low-volume and community hospitals.” – by Stacey L. Adams

Arch Surg. 2008;143;671-678.