TY  - JOUR
T1  - EFfect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer
AU  - Bilimoria KY, Talamonti MS, Wayne JD, et al
Y1  - 2008/07/21
N1  - 10.1001/archsurg.143.7.671
JO  - Archives of Surgery
SP  - 671
EP  - 678
VL  - 143
IS  - 7
N2  - Hypothesis 
    For 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.Design 
    Volume-outcome study.Setting 
    Academic research.Patients 
    Using 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 Measures 
    Multivariable logistic regression analysis was used to assess the effect of hospital type and volume on nodal evaluation (≥15 nodes).Results 
    Only 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).Conclusions 
    Nodal 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.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.143.7.671
UR  - http://dx.doi.org/10.1001/archsurg.143.7.671
ER  -