|
Back to 2016 Annual Meeting
Training Level of Gross Examiner Affects the Number of Lymph Nodes Identified for Microscopic Examination Following Esophagectomy
Patrick J. McLaren*1, Eugene Carneal2, Kyle D. Hart1, Ken Gatter3, John G. Hunter1, James P. Dolan1
1General Surgery, Oregon Health and Science University, Portland, OR; 2Pathology, Stanford University, Stanford, CA; 3Pathology, Oregon Health and Science University, Portland, OR
Background and Aims:
The presence of lymph node metastases in esophageal cancer is an important prognosticator of overall survival. Thus, an adequate lymphadenectomy during esophagectomy is essential to ensure accurate nodal staging. In addition, a thorough gross pathologic examination of the specimen to identify lymph nodes is essential. We hypothesized that the training level of the personnel performing the initial gross lymph node identification affects the number of nodes yielded for final microscopic examination.
Methods:
A single institution retrospective review of a prospectively maintained esophageal disease registry was performed from 2006 to 2015. Pathology reports were reviewed for the total number of lymph nodes recovered from esophagectomy specimens as well as the training level of the personnel performing the gross dissection. The number of nodes recovered by medical students, pathology residents, and physician’s assistants were compared using the Kruskal-Wallace test of variance.
Results:
A total of 207 patients with esophageal cancer treated by esophagectomy between July 2006 and July 2015 were included. Over the study period the average number of nodes harvested per case was 17.88. The average number of nodes harvested per case between 2006 and 2015 increased from 9.8 to 21.2 (Figure 1). The mean number of nodes harvested was lowest for medical students (16.3, n=25), then residents (20.1, n=103), and most for physician’s assistants (23.0, n=79). (p=0.007, Figure 2)
Conclusions:
Training level and experience are important factors affecting the number of lymph nodes harvested and submitted for microscopic examination following esophagectomy. More lymph nodes were harvested by more experienced personnel. With emphasis being placed on lymph node positivity for staging and prognosis, it is important that coordinated efforts between surgeons and pathologists are made to ensure maximum lymph node recovery.
Figure 1. Number of lymph nodes harvested per esophagectomy specimen, 2006-2015, n=207
  Figure 1. Number of lymph nodes harvested per esophagectomy specimen, 2006-2015, n=207
Figure2. Mean number of lymph nodes identified and standard error of mean for medical students, residents, and physician’s assistants; Kruskal-Wallace test of variance p=0.007
Back to 2016 Annual Meeting
|
