The focus on regional nodal evaluation in colon cancer as a staging measure, prognostic variable, and quality indicator is stronger now than ever before, with more than 300 peer-reviewed publications in 2009 specifically about lymph node staging, which emphasizes the critical role of this surgical and pathological factor. That lymph node evaluation as a staging measure is clinically relevant and that it is considered one of the most important prognostic markers in colorectal cancer are indisputable, yet only recently has the National Quality Forum with the American College of Surgeons and the American Society of Clinical Oncology endorsed the 12-node minimum as a colon cancer treatment quality measure. This benchmark is not to be underestimated, as it has had a profound effect, with now more than 94% of National Comprehensive Cancer Network–designated cancer centers not only pursuing but also achieving this new standard in surgical oncology. As with most advances in medicine, the 12-node minimum has engendered considerable controversy, which our group presented at this year's annual meeting of the American Surgical Association. One related and provocative question emerges from this debate. Is it the surgeon, the pathologist, or possibly even the patient who is the prognostic linchpin in colorectal cancer?
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