Good article in Archives here about inadequate lymph node harvests in colorectal cancer surgery.
One of the yardsticks for assessing the quality and oncologic adequacy of a surgical resection for colon cancer is to determine the number of lymph nodes harvested with the specimen. Lymph node status determines staging of the tumor and the need for adjuvant chemotherapy. We like to see at least 12 nodes in the specimen in order to state with confidence that a tumor is either node negative or node positive. Assessing fewer than 12 nodes risks understaging the disease and suggests the need for chemotherapy even if the seven or eight nodes available are negative. It also is construed as proof of "inadequate surgical resection" in many academic circles.
This paper suggests otherwise. Lymph node harvesting is affected by multiple factors including patient age, tumor stage, location of tumor in the colon, and the year the surgery was performed. Attributing a failure to harvest at least 12 nodes solely to the performing surgeon is overly presumptive.
I can attest to the findings of this paper. As surgeons, we've all done low anterior resections for a rectosigmoid tumor via the total mesorectal excision technique that completely cleans out the pelvis only to find that on the path report, only ten nodes were seen. It's disappointing but what can you do? There isn't anything else to cut out, other than to go back in there and start scraping against the sacrum with a rake. You know you've done an adequate oncologic resection but the cold hard numbers suggest some sort of failure. Papers like this perhaps will help attentuate some of the blame mentality (patient should have seen me, I always harvest 12 nodes!) that occurs within the surgical community...