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Objective An adequate lymph node harvest is necessary for accurate Dukes’ stage discrimination in colorectal cancer. The aim of this study is to identify the effect of variables, including the individual surgeon and pathologist, on lymph node harvest in a single institution. Method Three hundred and eighty one consecutive patients had resection for colorectal cancer, in a single unit. Factors influencing lymph node retrieval, including individual surgeon and reporting pathologist, were subjected to uni- and multivariate analysis. Actuarial survival of all patients with Dukes’ stage B and C disease was then calculated and survival compared between Dukes’ stage B and C at differing levels of lymph node harvest. Results The unit median lymph node harvest was 13 nodes/patient (95% CI 13.1–14.5). There was no difference in lymph node harvest between specialist colorectal surgeons and the pooled results of four nonspecialist consultant surgeons. However, there was a significant difference between reporting pathologists ( P < 0.001). On univariate analysis, operation type, operative urgency, Dukes’ stage, T-stage, reporting pathologist and use of neoadjuvant therapy in rectal cancer, were found to significantly affect lymph node retrieval. On multivariate analysis, operation type, T-stage, reporting pathologist and neoadjuvant therapy in rectal cancer remained significant variables. Patients with one or more lymph node metastasis had greater nodal harvests than those without (median 15 vs 12 P = 0.02). Survival of patients with Dukes’ stage B disease was found to improve as lymph node harvest increased. Conclusion Overall lymph node harvest, in this unit, varied according to the reporting pathologist but not operating surgeon. As lymph node harvest increased to 15 per patient, the probability of identifying a metastatic node increased. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the influence of social deprivation on postoperative mortality and length of stay in patients having surgery for colorectal cancer. Methods: Data were extracted from the Association of Coloproctology of Great Britain and Ireland database of patients presenting between April 2001 and March 2002. The effect of social deprivation, measured by the Townsend score, on 30-day postoperative mortality and length of stay was evaluated by two-level hierarchical regression analysis. Results: A total of 7290 (86.8 per cent) parents underwent surgery. Operative mortality was 6.7 per cent and median length of stay 11 days. Deprivation indices were significantly higher in patients with Dukes' 'D' cancers, undergoing emergency surgery and with higher American Society of Anesthesiologists (ASA) grades (P < 0.005). Worsening deprivation was associated with higher operative mortality and longer stay (P = 0.014). For each unit increase in deprivation, there was 2.9 (95 per cent confidence interval 0.5 to 5.2) per cent increase in 30-day mortality. On multitfactorial analysis, social deprivation was an independent predictor of length of stay, but its effect on operative mortality was explained by differences in ASA grade, operative urgency and Dukes' classification. Conclusion: Social deprivation was an independent risk factor of postoperative length of stay and associated with higher postoperative mortality. These results have important implications for risk modelling of postoperative outcomes. [ABSTRACT FROM AUTHOR]

Introduction: NICE has set standards for lymph node (LN) harvest in surgery for colorectal cancer (CRC). We report the effect of the operating surgeon and reporting pathologist on lymph node yield and the role of LN yield on survival. Method: Data on all patients with CRC treated in a single unit between 1999 and 2004 were collected in the ACPGBI database. Lymph node harvest was identified for each of three surgeons and three pathologists. Actuarial survival of all patients with Dukes’ stage B with greater than or less than 8 reported LNs and Dukes’ stage C were compared using log-rank test (Kaplan–Meier method). Results: A total of 380 cases had a curative resection with a unit median LN retrieval of 13. There was no difference in survival between Dukes’ stage B <8 LN (mean 42 months, 95% CI 29–55) and Dukes stage C (mean 45 months, 95% CI 29–51), log-rank P = 0.7618. Survival between Dukes stage B (8 LN and Dukes C was significantly different (mean 58 months, 95% CI 53–64 vs 45 months, 95% CI 29–51), log-rank P = 0.006. Conclusions: This study demonstrates that within a single unit the reporting pathologist significantly influences LN yield in CRC treatment and that a minimum of eight lymph nodes needs to be examined to stage CRC as Dukes’ C accurately. In this unit the surgeon was not a significant variable. [ABSTRACT FROM AUTHOR]