• Karl Y Bilimoria, Mark S Talamonti, Jeffrey D Wayne, James S Tomlinson, Andrew K Stewart, David P Winchester, Clifford Y Ko, and David J Bentrem.
• Cancer Programs, American College of Surgeons, Chicago, Illinois, USA. k-bilimoria@northwestern.edu
• Arch Surg. 2008 Jul 1; 143 (7): 671-8; discussion 678.

HypothesisFor gastric and pancreatic cancer, regional lymph node evaluation is important to accurately stage disease in a patient and may be associated with improved survival. We hypothesized that National Comprehensive Cancer Network (NCCN), National Cancer Institute (NCI)-designated institutions, and high-volume hospitals examine more lymph nodes for gastric and pancreatic malignant neoplasms than do low-volume centers and community hospitals.DesignVolume-outcome study.SettingAcademic research.PatientsUsing the National Cancer Data Base (January 1, 2003, to December 31, 2004), patients were identified who underwent resection for gastric (n = 3088) and pancreatic (n = 1130 [pancreaticoduodenectomy only]) cancer.Main Outcome MeasuresMultivariable logistic regression analysis was used to assess the effect of hospital type and volume on nodal evaluation (>or=15 nodes).ResultsOnly 23.2% of patients with gastric cancer and 16.4% of patients with pancreatic cancer in the United States underwent evaluation of at least 15 lymph nodes. Patients undergoing surgery had more lymph nodes examined at NCCN-NCI hospitals than at community hospitals (median, 12 vs 6 for gastric cancer and 9 vs 6 for pancreatic cancer; P < .001). Patients at highest-volume hospitals had more lymph nodes examined than patients at low-volume hospitals (median, 10 vs 6 for gastric cancer and 8 vs 6 for pancreatic cancer; P < .001). On multivariable analysis, patients undergoing surgery at NCCN-NCI and high-volume hospitals were more likely to have at least 15 lymph nodes evaluated compared with patients undergoing surgery at community hospitals and low-volume centers (P < .001 and P =.02, respectively).ConclusionsNodal examination is important for staging, adjuvant therapy decision making, and clinical trial stratification. Moreover, differences in nodal evaluation may contribute to improved long-term outcomes at NCCN-NCI centers and high-volume hospitals for patients with gastric and pancreatic cancer.

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