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Lymph Node Sampling in Colon Cancer Surgery

Key findings

The vast majority (94%) of surgical reports completed following colon surgery (resection reports) confirm that 12 or more lymph nodes have been examined.

Why is this important to Ontarians?

  • The Cancer Care Ontario guideline, Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes recommends that, for colon cancer patients, 12 or more lymph nodes be removed and examined. The guideline recognizes that this will not be possible in 100% of patients.
  • Checking lymph nodes for cancer cells allows accurate staging of the cancer. There is consensus that examination of 12 or more nodes is needed to adequately stage colorectal cancer.
  • Determining the right stage is crucial to making sure the individual receives the most appropriate care after the operation (radiation, chemotherapy or none). Optimal staging of colon cancer is also an important part of establishing the person’s prognosis (likely outcome) and the course of their disease.
  • People whose lymph nodes are positive for cancer have a worse prognosis and are more likely to have recurrence (return) of the cancer or to have the cancer spread to other parts of the body.[1]

See Lymph Node Sampling in Colon Cancer Surgery Methodology for technical information.

Report date: March 2019
Data sources: Pathology Datamart – Enterprise Data Warehouse
Prepared by: Analytics and Informatics, Cancer Care Ontario

Data Table 1: Percentage of colon cancer surgery reports with 12 or more nodes examined, 2013 to 2017
Calendar Year Percentage Colon Cancer Surgery Reports with 12 or more lymph nodes examined
2013 90.8
2014 91.6
2015 92.2
2016 93.3
2017 94.5

Report date: March 2019
Data sources: Pathology Datamart – Enterprise Data Warehouse
Prepared by: Analytics and Informatics, Cancer Care Ontario

Results

  • In Ontario, 94% of colon cancer resection reports show that 12 or more lymph nodes have been examined. This represents 3,394 reports.
  • This exceeds the target of 90% and is in keeping with Cancer Care Ontario’s best practice quality guidelines.
  • The colon cancer surgery resection report rate has been performing above the 90% target since 2013.

Comparisons

Getting comparable data and measures from multiple jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

  • Ontario continues to perform very well compared with other provinces in Canada, as most patients (94%) have 12 or more lymph nodes removed and examined for cancer staging. In 2014, among participating provinces, the percentage of colon cancer patients with 12 or more lymph nodes removed and examined ranged from 71% to 91%. Specifically, the rates by province: Alberta – 79%, Saskatchewan – 75%, Manitoba – 91%, New Brunswick – 84%, Nova Scotia – 71%, Prince Edward Island – 74%, Newfoundland and Labrador – 90%.[2]
  • Scotland also recognizes that maximizing the number of lymph nodes resected and examined allows for reliable staging, which influences treatment decisions. In Scotland, 86% of colorectal cancer patients having surgical resection had 12 or more lymph nodes examined. These patients were diagnosed during April 2013 to March 2014.[3]

Highlights

  • Cancer Care Ontario continuously performs above the 90% target for this indicator and works with surgical communities of practice to maintain this high performance.

For more information

For more information about the Surgical Oncology Program, visit the Surgical Oncology Program on Cancer Care Ontario’s website.

Visit Quality Improvement Resources for Surgical Oncology for resources to help physicians learn about, discuss and provide feedback on quality issues.

References

  1. Smith AJ, Driman DK, Spithoff K, McLeod R, Hunter A, Rumble RB, Langer B and Expert Panel on Colon and Rectal Cancer Surgery and Pathology. Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes Guideline Recommendations. 2008.
  2. Canadian Partnership Against Cancer. 2018 Cancer System Performance Report [Internet]. (2018) [cited 2019, April 08]. Available from https://www.systemperformance.ca/report/2018-cancer-system-performance-report/
  3. National Health Service Scotland. Colorectal Cancer Quality Performance Indicators [Internet]. (2015) [cited 2019, April 08a]. Available from https://www.isdscotland.org/Health-Topics/Quality-Indicators/Publications/2015-06-23/2015-06-23-Colorectal-QPI-Report.pdf