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Lymph Node Sampling in Colon Cancer Surgery Methodology

Colon Lymph Node Retrieval Rate
Short description of Indicator Percentage of colon cancer surgery reports with 12 or more nodes examined
Rationale for measurement

The Ontario Health (Cancer Care Ontario) guidelines, “Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes Guideline Recommendations, recommend that, for colon cancer patients, 12 or more lymph nodes be removed and examined. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/566

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 patient receives the most appropriate care after the operation (for example, radiation, chemotherapy or neither). Optimal staging of colon cancer is also an important part of establishing the patient’s prognosis (likely outcome) and course of disease. Patients whose lymph nodes are positive for cancer have a worse prognosis and are more likely to have recurrence (return) of the cancer or have the cancer spread to other parts of the body.[1]  


  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.
Evidence/references for rationale

Recommendations for improving the quality of colon cancer surgery including margin and lymph assessment can be found in a guideline released in 2016. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/566

Calculations for the indicator % Colon Cancer Surgery Reports with 12 or more lymph nodes examined = (Number of colon cancer surgery reports with 12 or more lymph nodes examined)/(Number of colon surgery reports)
Standardized Rate Calculation N/A
Unit Percentage (%)
Data sources Pathology Data Mart
Time Frame CY 2013-2017
Geographic Scale Provincial
Denominator description

Patients that had colon cancer resection and information on of lymph nodes was specified, or no lymph nodes were submitted or found.

Primary tumour site is one of the following:

  • Cecum
  • Right (ascending) colon
  • Hepatic flexure
  • Transverse colon
  • Splenic flexure
  • Left (Descending) colon
  • Sigmoid colon
  • Colon, Not Overwise Specified
  • Ileocecal valve
Numerator description Reports where field "Regional Lymph Nodes Examined" is stated with numeric value 12 or greater​
Considerations  N/A
Data availability & limitations

Excludes:

  • All non-cancer cases
  • Reports not received in discrete data field format (i.e., narrative reports)
  • ICDO-3 behaviors of 0 (benign), 1 (borderline), 6 (metastatic) and 2 (in situ)
  • Consults
  • All report types other than surgical pathology reports; (i.e., biopsies are excluded)
  • Reports from private labs and pediatric hospitals
  • Reports that have both colon and rectum locations marked
  • Reports where no tumour site is specified
  • Reports where no information on lymph nodes was specified
  • Reports that contain information on both colon and rectal resection​