This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Related letters  • Similar articles in JAMA  Topic Collections  • Quality of Care, Other  • Prognosis/ Outcomes  • Oncology  • Colon Cancer  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In their study examining the association of hospital nodal evaluation rates and survival after colectomy for cancer, Dr Wong and colleagues¹ concluded that examination of increasing numbers of lymph nodes is not associated with survival at the hospital level and that evaluation of 12 or more lymph nodes is not a useful quality measure.

However, their data actually demonstrate a significant improvement in survival in a key population. Table 3 shows a survival advantage for stage II patients treated at hospitals with high lymph node examination rates (adjusted hazard ratio, 0.85; 95% confidence interval, 0.74-0.96). The patients who would benefit most from having 12 or more nodes examined are stage II patients who have had an inadequate number of lymph nodes examined to confidently deem them free of nodal metastases. These understaged patients would fail to receive the potentially lifesaving benefits of adjuvant chemotherapy.² When examined in . . . [Full Text of this Article]

Karl Y. Bilimoria, MD; Andrew K. Stewart, MA
American College of Surgeons
Chicago, Illinois

Stephen B. Edge, MD
Department of Surgery
Roswell Park Cancer Institute
Buffalo, New York

Clifford Y. Ko, MD, MS, MSHS
cko@mednet.ucla.edu
American College of Surgeons

RELATED ARTICLE

Hospital Lymph Node Examination Rates and Survival After Resection for Colon Cancer
Sandra L. Wong, Hong Ji, Brent K. Hollenbeck, Arden M. Morris, Onur Baser, and John D. Birkmeyer
JAMA. 2007;298(18):2149-2154.
ABSTRACT | FULL TEXT  

RELATED LETTERS

Lymph Node Examination Rate, Survival Rate, and Quality of Care in Colon Cancer
Elke Peters, Iris D. Nagtegaal, Cornelius J. H. van de Velde, and J. Han van Krieken
JAMA. 2008;299(8):896-897.
EXTRACT | FULL TEXT  

Lymph Node Examination Rate, Survival Rate, and Quality of Care in Colon Cancer—Reply
Sandra L. Wong and John D. Birkmeyer
JAMA. 2008;299(8):897-898.
EXTRACT | FULL TEXT