• Sukhyung Lee, Luke J Hofmann, Kurt G Davis, and Brad E Waddell.
• Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA. Sukhyung.lee@amedd.army.mil
• Ann. Surg. Oncol. 2009 Nov 1;16(11):3080-6.

BackgroundImproved survival is associated with an increased number of lymph nodes (LNs) examined. The aim of this study was to assess whether the examination of >or=12 LNs is associated with more accurate colon cancer staging.MethodsWe queried the Department of Defense Automated Central Tumor Registry database for stage I-III colon cancer patients. Logistic regression analysis was performed to determine whether the examination of >or=12 LNs is associated with increased rates of LN-positive colon cancer. Kaplan-Meier and Cox proportional hazard analysis was performed to evaluate the effect of number of LNs examined on survival.ResultsThe rate of LN-positive colon cancer is significantly higher with increasing number of LNs examined (1-3 LNs examined: 31% vs. >12 LNs examined: 41%, P<.001). Logistic regression analysis adjusting for patients, tumor, and hospital characteristics showed that examination of >or=12 LNs is associated with a >30% increase in detecting a LN-positive colon cancer (odds ratio, 1.350; 95% confidence interval, 1.175-1.511). The evaluation of >or=12 LNs is associated with improved survival in LN-negative colon cancer patients (P<.001).ConclusionsOur study demonstrates that the proportion of LN-positive colon cancer is far higher when >or=12 LNs are examined. Examination of >or=12 LNs may improve staging accuracy and outcome with optimal use of systemic chemotherapy.

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