Too Few Lymph Nodes Are Being Removed During Stomach Cancer Surgery in the United States

May 15, 2005A new study shows that one quarter of people undergoing surgery for stomach cancer have the recommended number of lymph nodes removed, that this number varies widely by geographic region, and that adequate lymph node removal is related to people surviving this cancer.Lymph nodes are tiny, bean-shaped glands that help fight infection. When cancer cells start to spread to other parts of the body, they first go to the lymph nodes. During stomach cancer surgery, doctors remove a number of these lymph nodes and examine them for evidence of cancer. The more lymph nodes that are removed and examined, the more certain a doctor can be about how far the cancer has spread. This information helps determine the stage (description) of the cancer and guides treatment decisions. In 1997, the American Joint Committee on Cancer (AJCC) determined that 15 lymph nodes should be removed and assessed in people having stomach cancer surgery.In this study, investigators analyzed 11,602 records in the Surveillance, Epidemiology, and End Results (SEER) database of people who had surgery to remove their stomach cancer from 1988 to 2001. They found that 15 or more lymph nodes were removed in only 27.6% of the people. In addition, this percentage varied among geographic regions. For example, enough lymph nodes were removed in 52.5% of people in Hawaii, but only 17.5% of people in Utah had the correct number of lymph nodes removed.Furthermore, survival of these patients five years after diagnosis strongly related to the number of lymph nodes removed during surgery. More than twice as many patients (33.4%) in Hawaii, where the average number of lymph nodes removed was 15, were alive five years after their cancer diagnosis compared with Utah (16.2%), where the average number of lymph nodes removed was six.The researchers cautioned that survival is probably not directly related to the number of lymph nodes removed during surgery. Instead, this measurement is probably a marker of the overall quality of care a patient receives."Our study showed that three-quarters of patients undergoing gastric cancer surgery are not having the recommended number of lymph nodes removed, said Natalie G. Coburn, MD, MPH, Surgical Oncology Fellow at the University of Toronto, and lead author of the study. "Patients need to be aware that this may lead to an inaccurate prognosis (estimate of a patient's chance of recovery) and less aggressive treatment after surgery."What This Means for PatientsPatients having stomach cancer surgery should talk to their doctors in advance about the details of their surgeries that may affect their treatment and recovery, including the number of lymph nodes that will be removed.