The central tenets of cancer staging are accuracy, prognostic significance, and therapeutic implications. For solid tumors, accurate cancer staging is highly dependent on the evaluation of sufficient numbers of regional lymph nodes to ensure that positive nodes, if present, will be detected. Positive nodes are markers for disease spread and therefore for patients with a higher risk of recurrence and metastatic disease.1 Staging influences treatment decisions because adjuvant chemotherapy for patients with positive lymph node findings has been shown to be efficacious in improving disease-free and overall survival.2 Observational studies have suggested that very thorough lymph node searches are warranted because of this relationship between lymph node positivity, the subsequent decision to administer chemotherapy, and improved survival.1 Consequently, retrieval and examination of at least 12 lymph nodes during colon cancer resection has been established as a quality indicator for colon cancer care.3 With increasing demand for higher-quality cancer care, quality indicators serve as benchmarks by which physicians, payers, and policy makers can measure and improve processes of care and patient outcomes.
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