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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

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