Division of Gastrointestinal Surgery, Colon and Rectal Surgery Program, Massachusetts General Hospital, Boston, MA 02114, USA.
Int J Colorectal Dis. 2011 Sep;26(9):1163-8. doi: 10.1007/s00384-011-1240-6. Epub 2011 May 15.
Lymph node (LN) yield is a critical component of colon cancer staging and is often a surrogate for quality assessment in surgery. We investigated the impact of pathologists' training on LN harvest.
This is a retrospective review on 137 patients undergoing elective colectomy for adenocarcinoma at a single institution from 2008 to 2009. We studied surgeon-, patient- and pathologist-derived factors, and identified independent variables affecting LN yield using logistic regression.
LN yield was similar between open and laparoscopic resections (21 versus 23, p = 0.54). Similarly, nodal counts were independent of tumor location (p = 0.08) and no difference was noted between colorectal and general surgeons (24 versus 21, p = 0.31). Strikingly, the number of LNs reported by PGY-1 pathology residents was significantly higher than those with two or more years of training (24 versus 19, p = 0.02). On logistic regression, only the reporting pathologists' year in training remained a significant predictor of the number of nodes reported (OR = 5.28, p = 0.0001).
LN retrieval in patients with colon cancer is inversely related to the interpreting pathologists' level of training.
淋巴结（LN）检出量是结肠癌分期的关键组成部分，通常也是手术质量评估的替代指标。我们研究了病理学家培训对 LN 检出量的影响。
这是对 2008 年至 2009 年在一家机构接受择期结肠癌根治术的 137 例患者进行的回顾性研究。我们研究了外科医生、患者和病理学家相关的因素，并使用逻辑回归分析确定了影响 LN 检出量的独立变量。
开放和腹腔镜手术的 LN 检出量相似（21 与 23，p = 0.54）。同样，淋巴结计数与肿瘤位置无关（p = 0.08），结直肠外科医生与普通外科医生之间也没有差异（24 与 21，p = 0.31）。引人注目的是，PGY-1 病理住院医师报告的 LN 数量明显高于接受了两年以上培训的住院医师（24 与 19，p = 0.02）。在逻辑回归中，只有报告病理医师的培训年限仍然是报告的淋巴结数量的显著预测因素（OR = 5.28，p = 0.0001）。
结肠癌患者的 LN 检出量与解读病理医师的培训水平呈反比。
