Index

Show indicators by:

  • Cancer Control Domain
  • Disease Site
  • Dashboard
  • Cancer control domain
    • 1. Prevention
      • Smoking Prevalence
      • Smoking behaviours in current cancer patients
      • Smoking Cessation
      • Second-Hand Smoke Exposure
      • Alcohol Consumption
      • Adult Overweight and Obesity
      • Human Papillomavirus (HPV) Vaccination
      • Active Transportation
      • Fruit and Vegetable Consumption
    • 2. Screening
      • Cervical Cancer Screening
      • Breast Cancer Screening
      • Colorectal Cancer Screening
      • PSA Testing
      • Screening in Underserved Populations
    • 3. Diagnosis
      • Breast Cancer Diagnosis Wait Times
      • Colorectal Cancer Diagnosis Wait Times
      • Capture of Stage
      • Stage Distribution
      • Prostate Risk Profile
      • Prostate Stage-Specific Incidence
    • 4. Treatment
      • Surgery
        • Removal and Examination of 12 or More Lymph Nodes in Colon Resections
        • Resection Rates for Stage II or III Rectal Cancer, Stage III Colon Cancer and Stage II or IIIA Non-Small Cell Lung Cancer Patients
        • The Use of Breast-Conserving Surgery versus Mastectomies for Breast Cancer Resections
        • High-Risk, Resource-Intensive Surgeries for Esophageal, Pancreatic, Liver, Lung and Ovarian Cancers in Canada
        • Prostate Wait Times for Surgery
        • Radical Prostatectomy: Open versus Laparoscopic Surgery
      • Radiation Therapy
        • Radiation Therapy Wait Times
        • Radiation Therapy Utilization and Capacity
        • Pre-operative Radiation Therapy for Patients with Stage II or III Rectal Cancer
        • Post-Operative Radiation Therapy for Patients with Stage I or II Breast Cancer
        • Prostate Wait Times for Radiation Therapy
        • Prostate Patterns of Care: Radiation and Surgical Treatment
      • Systemic Therapy
        • Post-Operative Chemotherapy for Stage III Colon Cancer Patients
        • Post-Operative Chemotherapy for Patients with Stage II or IIIA Non-Small Cell Lung Cancer
    • 5. Person-Centred Perspective
      • Screening for Distress
      • Patient Satisfaction
      • Place of Death
      • Prostate Place of Death
      • Prostate Patient Satisfaction with Care
      • Prostate Access to Palliative Radiation
    • 6. Research
      • Adult Clinical Trial Participation
      • Prostate Clinical Trials Participation
      • Pediatric Clinical Trial Participation
      • Cancer Research Investment
      • Prostate Cancer Research Investment
    • 7. Appropriateness
      • Breast Cancer Screening Outside of Guidelines
      • Breast Cancer Mastectomies Done as Day Surgery
      • Intensive care use in the last two weeks of life
    • 8. Long-Term Outcomes
      • Breast Cancer
      • Lung Cancer
      • Colorectal Cancer
      • Prostate Cancer
      • Prostate Long-Term Outcomes
      • Pancreatic Cancer
      • Ovarian Cancer
      • Five-year net survival by income quintile for several cancers in Canada
  • Disease Site
    • Breast
      • Breast Cancer Screening
      • Screening in Underserved Populations
      • Breast Cancer Diagnosis Wait Time
      • Capture of Stage
      • Stage Distribution
      • Surgery
        • Breast Cancer Resections That Are Mastectomies
        • The Use of Breast-Conserving Surgery versus Mastectomies for Breast Cancer Resections
      • Radiation Therapy
        • Post-Operative Radiation Therapy for Stage I or II Breast Cancer Patients
      • Place of Death
      • Adult Clinical Trial Participation
      • Cancer Research Investment
      • Breast Cancer Screening Outside Recommended Guidelines
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Colorectal
      • Colorectal Cancer Screening
      • Screening in Underserved Populations
      • Colorectal Cancer Diagnosis Wait Time
      • Capture of Stage
      • Stage Distribution
      • Surgery
        • Removal and Examination of 12 or More Lymph Nodes in Colon Resections
        • Resection Rates for Stage II or III Rectal Cancer, Stage III Colon Cancer and Stage II or IIIA Non-Small Cell Lung Cancer Patients
      • Radiation Therapy
        • Pre-operative Radiation Therapy for Patients with Stage II or III Rectal Cancer
      • Post-Operative Chemotherapy for Stage III Colon Cancer Patients
      • Place of Death
      • Adult Clinical Trial Participation
      • Cancer Research Investment
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Lung
      • Capture of Stage
      • Stage Distribution
      • Resection Rates for Stage II or IIIA Non-Small Cell Lung Cancer Patients
      • Post-Operative Chemotherapy for Stage II or IIIA Non-Small Cell Lung Cancer Patients
      • Place of Death
      • Adult Clinical Trial Participation
      • Cancer Research Investment
      • Incidence and mortality rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Prostate
      • PSA Testing
      • Prostate Stage-Specific Incidence
      • Prostate Risk Profile
      • Capture of Stage
      • Stage Distribution
      • Prostate Wait Times for Surgery
      • Prostate Wait Times for Radiation Therapy
      • Radical Prostatectomy: Open versus Laparoscopic Surgery
      • Prostate Patterns of Care: Radiation and Surgical Treatment
      • Prostate Patient Satisfaction with Care
      • Prostate Place of Death
      • Prostate Access to Palliative Radiation
      • Prostate Clinical Trials Participation
      • Adult Clinical Trial Participation
      • Prostate Cancer Research Investment
      • Cancer Research Investment
      • Incidence & Mortality Rates
      • Five-year net survival by income quintile for several cancers in Canada
    • Cervical
      • Human Papillomavirus (HPV) Vaccination
      • Cervical Cancer Screening
      • Screening in Underserved Populations
    • Pancreas
      • Incidence and mortality rates
    • Ovarian
      • Stage Distribution
      • Incidence and mortality rates
  • Province & Territory
System Performance Logo
System Performance
  • About
  • Reports
  • Français
  • Home
  • Cancer control domain
  • 4. Treatment
  • Surgery
  • Removal and Examination of 12 or More Lymph Nodes in Colon Resections

Removal and Examination of 12 or More Lymph Nodes in Colon Resections

  • Charts and Tables

    Charts and Tables

    Figure 4.1

    Percentage of colon resections with 12 or more lymph nodes removed and examined, by province — from 2009 to 2012 diagnosis years

    • Download & Export

      Figure

      •  

      Data Table

      • CSV
      • Excel
      • Json
      • XML

    “—” Data not available
    AB: All Alberta Cancer Registry coded surgeries (if there was no more definitive surgery as part of initial treatment, polypectomy might be included) were included as complete colon resection. C18.1 Appendix was excluded in 2012.
    ON: Data represent colon cases with 12 or more nodes examined rather than cases diagnosed in corresponding year.
    NS: Collaborative stage variables were used to identify resections. Resection dates were manually retrieved through chart review.
    NL: Did not include out-of-province treatment for provincial residents.
    Data source: Provincial cancer agencies or registries.

    Data Table

    Province Diagnosis year Number of resections with =>12 lymph nodes Percent (%)Lower bound of 95% confidence intervalUpper bound of 95% confidence interval
    BC2009----
    BC2010----
    BC2011----
    BC2012----
    AB200977079.276.581.7
    AB201078780.477.882.8
    AB201181581.378.883.7
    AB201276683.080.485.4
    SK200922862.156.967.1
    SK201024069.264.074.0
    SK201126574.469.678.9
    SK201227174.269.478.7
    MB200932075.871.579.8
    MB201034779.475.383.1
    MB201136080.976.984.4
    MB201230682.378.086.0
    ON2009----
    ON20101,98188.887.590.1
    ON20113,00389.688.590.6
    ON2012----
    QC2009----
    QC2010----
    QC2011----
    QC2012----
    NB200913558.752.065.1
    NB201014861.755.267.8
    NB201120274.368.679.4
    NB201221777.872.482.5
    NS200928369.965.274.3
    NS201033572.568.276.5
    NS201125076.571.580.9
    NS201230176.471.980.5
    PE20093461.847.774.6
    PE20103364.750.177.6
    PE20115371.659.981.5
    PE20124170.757.381.9
    NL200920375.569.980.5
    NL201021282.577.386.9
    NL201124283.278.487.3
    NL201223681.977.086.2

    + Expand Table

    “—” Data not available
    AB: All Alberta Cancer Registry coded surgeries (if there was no more definitive surgery as part of initial treatment, polypectomy might be included) were included as complete colon resection. C18.1 Appendix was excluded in 2012.
    ON: Data represent colon cases with 12 or more nodes examined rather than cases diagnosed in corresponding year.
    NS: Collaborative stage variables were used to identify resections. Resection dates were manually retrieved through chart review.
    NL: Did not include out-of-province treatment for provincial residents.
    Data source: Provincial cancer agencies or registries.

  • About this indicator

    About this indicator

    Key message

    There have been steady improvements in the percentage of colon resections with 12 or more lymph nodes removed and examined from 2009 to 2012—this suggests greater adherence to evidence-based guidelines.


    Indicator definition

    The percentage of colon resections with 12 or more lymph nodes removed and examined for cases diagnosed from 2009 to 2012. Results are presented by province, age group and sex.


    Target

    90%, established in 2014 by the Partnership’s System Performance Targets and Benchmarks Working Group.


    Measured since

    The 2010 Cancer System Performance Report.


    Why measure this?

    The removal and examination of 12 or more lymph nodes is important for proper staging and subsequent treatment planning and has been associated with improved survival.1-3 Most clinical guidelines recommend that a minimum of 12 lymph nodes be removed and then examined by a pathologist to more definitively establish a cancer’s nodal status—an indication of the extent of cancer spread to the lymph nodes.4, 5

    The recommendation is based on the fact that the chance of false negative nodal staging (i.e., the test fails to demonstrate that the cancer has in fact spread) is reduced to acceptable levels when a minimum of 12 lymph nodes are examined. Measuring provincial treatment patterns relative to this guideline can help identify variations and inform opportunities for quality improvement at the provincial level.


    What are the key findings?

    • In the 2012 diagnosis year, the percentage of colon resections with 12 or more lymph nodes removed and examined ranged from 70.7% in Prince Edward Island to 83.0% in Alberta; none of the reporting provinces achieved the target of 90% of colon resections with a minimum of 12 lymph nodes examined (Figure 4.1).
    • Ontario achieved the target in 2011, but did not provide data for 2012 (Figure 4.1).
    • The percentage of colon resections with a minimum of 12 lymph nodes examined was slightly higher for women aged 18–69 than for men in the same age group (83.1% vs. 78.9%), and also slightly higher for women aged 70 or older than for men in the same age group (81.3% vs. 76.6%) (data not shown).
    • The percentage of colon resections with 12 or more lymph nodes examined increased in all reporting provinces from 2009 to 2012 (Figure 4.1).

    Why do these findings matter?

    There have been steady improvements across all provinces with respect to the percentage of colon resections with 12 or more lymph nodes removed and examined as per evidence-based guidelines. This pattern has positive implications for patients, such as better cancer staging and subsequent treatment planning, which has been associated with improved survival.1-3

    Several factors may have influenced the increasing trend, such as published evidence-based guidelines, public reporting and the implementation of quality improvement initiatives. One pan-Canadian quality improvement initiative is the Electronic Synoptic Pathology Reporting Initiative, which has participation from British Columbia, Manitoba, Ontario, New Brunswick, Nova Scotia and Prince Edward Island. The initiative will facilitate the implementation of electronic synoptic pathology reporting for several cancers, including colorectal cancer, to improve the quality of reporting. High-quality pathology reporting has the potential to lead to improved alignment with evidence-based guidelines (e.g., removal and examination of at least 12 lymph nodes), better care planning and improved patient outcomes.


    References

    1. Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003 Aug 1;21(15):2912-9.
    2. Bilimoria KY, Palis B, Stewart AK, Bentrem DJ, Freel AC, Sigurdson ER, et al. Impact of tumor location on nodal evaluation for colon cancer. Dis Colon Rectum. 2008 Feb;51(2):154-61.
    3. Lykke J, Roikjaer O, Jess P. The relation between lymph node status and survival in Stage I-III colon cancer: results from a prospective nationwide cohort study. Colorectal Dis. 2013 May;15(5):559-65.
    4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer Version 2.2016. 2015.
    5. Smith AJ, Driman DK, Spithoff K, McLeod R, Hunter A, Rumble RB, et al. Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes. Toronto (ON): 2008. 66 p.
  • Data specifications

    Data specifications

    Definition: The percentage of colon resections with 12 or more lymph nodes removed and examined

    Numerator: Invasive colon cancer cases that were resected with 12 or more lymph nodes removed and examined within one year of diagnosis

    Denominator: All invasive colon cancer cases resected within 12 months of diagnosis

    Data source: Provincial cancer agencies

    Measurement timeframe: 2009, 2010, 2011 and 2012 diagnosis years

    Stratification variables: Province, age group, sex

    Provinces submitting data: AB, SK, MB, ON, NB, NS, PE, NL

    Province specific notes:

    • AB: For 2009/2010/2011/2012/, treatment information is based on initially planned treatment to primary site (Alberta Cancer Registry (ACR) data). The Canadian Classification of Health Interventions (CCI) codes are not used by the ACR; as such, all coded surgeries were included for complete colon resection. If more than one surgical procedure is performed as a part of the initial treatment, the most definitive procedure is documented. The definition of definitive is the surgical procedure with the intent to cure. Through quality assurance, there were a number of the cases coded as surgery on the ACR but that had CCI codes or billing codes other than the ones listed. The majority of these cases appear to be cases in which the DAD had resection of the rectum even though the patient only had C18.7 sigmoid colon. For 2010/2011/2012, cases for C18.1 Appendix were excluded. However, there were also some cases in which the ACR codes surgery for polypectomy and hence these had also been included in 2011. There are also some cases in which the ACR codes surgery for colon but no records were found in the Inpatient database or billing data. This may be out of province resection in 2012. Data did not limit to complete resection (colectomy) in 2009.
    • ON: Data were generated by the CSQI methodology. 2010 data were for colon cancer cases with 12 or more lymph nodes examined in 2010 rather than colon cancer cases that were diagnosed in 2010. Cases for Appendix C18.1 were excluded in 2011.
    • NS: For 2011, collaborative stage variables were used to identify those having a resection. Resections dates manually reviewed from chart review.
    • PE: For 2009, the CS Extension Evaluation code (=3) was used to meet AJCC pathological criteria for staging. For 2011, cases for Appendix C18.1 were excluded.
    • NL: For 2009/2010, data did not limit to complete sections (colectomy).

    Notes:

    1. Colon cases were defined as ICDO3 codes: C18.0 to 18.9 with behavior code 3 (malignant).
    2. Excluded cases with lymphoma Codes M-95 to M-98, sarcoma codes (see Appendix 1), neuroendocrine carcinoma, squamous cell carcinoma were excluded.
    3. Cases for patients under 18 years of age (at diagnosis) were excluded.
    4. Colon resections identified using CCI codes: 1NM87 or 1NM89 or 1NM91 or list of descriptors in Appendix 1.
    5. All resected cases were included, regardless of margin status.
    6. Cases with unknown number of nodes removed and examined were excluded from both numerator and denominator.
    7. Included cases where the last resection date (if multiple) – diagnosis date <=365 days.
  • Related indicators

    Related Indicators

    Resection Rates for Stage II or III Rectal Cancer, Stage III Colon Cancer and Stage II or IIIA Non–Small Cell Lung Cancer Patients

    Percentage of Stage II or IIIA non-small cell lung cancer patients who had a surgical resection†, by province — from 2009 to 2012 diagnosis years
    View this indicator
    Post-Operative Chemotherapy for Stage III Colon Cancer Patients

    Percentage of Stage III colon cancer patients receiving chemotherapy following surgical resection, by age group — from 2009 to 2012 diagnosis years
    View this indicator
    Colorectal Cancer

    Incidence and mortality rates for colorectal cancer, by sex, Canada, age-standardized to the 2011 Canadian population — from 1992 to 2012
    View this indicator
  • About Us
  • Careers
  • Contact
  • Media centre
  • Share your feedback
  • About our new site

  • Français Language toggle.

Other related sites:

  • Canadian Partnership for Tomorrow Project
  • Canadian Cancer Research Alliance
  • Canadian Cancer Trials
  • facebook
  • twitter
  • youtube
  • linkedin
    CPAC Logo

    Questions about cancer?

    For information about cancer treatment and support for patients, please contact the Canadian Cancer Society at 1-888-939-3333 or by completing this online form.

  • AODA compliance
  • Privacy policy
  • Terms of use
  • FAQ
  • Site map
  • About this site
© Canadian Partnership Against Cancer Corporation