Proportion of rectal cancer cases where at least 12 lymph nodes are reported in pathology

Why this indicator is important

Rectal cancers are often grouped together with colon cancers, and this group of cancers is referred to as 'bowel cancer'.

There has been rapid development in the diagnosis and treatment of rectal cancer in the past decade.

The management of rectal cancer requires a multidisciplinary cancer care team (MDT) of health care professionals with experience in rectal cancer treatment including surgery, who also provide appropriate care following treatment.

Given the complexity of treating rectal cancer, it is recommended that people receive treatment at a facility which, in addition to having a MDT, also performs this surgery regularly.

Evidence shows a positive association between the number of lymph nodes examined and survival for people with rectal cancer.1,2 To determine accurate cancer staging, clinical guidelines recommend collecting at least 12 associated pelvic lymph nodes during surgery for rectal cancer.3

About this indicator

This indicator relates to the number of pelvic lymph nodes collected during rectal cancer surgery, and examined by a pathologist.

  • Between 2014-2017, 83% of NSW rectal cancer cases (excluding cases receiving neoadjuvant therapy) had 12 or more nodes examined.

Proportion of cases with 12 or more lymph nodes examined (excluding cases receiving neoadjuvant therapy*), rectal cancer, by local health district (LHD) of residence**, NSW, 20142017

N = Number of rectal cancer cases with nodes collected during and examined following primary resection.

* Cases were excluded based on neoadjuvant therapy treatment data available in the NSW Cancer Registry (NSWCR) as of August 2020. At this time the NSWCR was incomplete for treatment.

** LHD of residence relates to the address of residence at time of rectal cancer diagnosis.

R = Range of LHD proportions.


  1. Data source: NSW Cancer Registry.
  2. The number of nodes examined were recorded from pathology reports of the primary rectal cancer resection where present as a scanned image in the NSWCR. Cases were excluded where neoadjuvant therapy treatment could be ascertained. The NSWCR may not have a primary resection if the pathology report was missing or resections were performed interstate (cross-border patients)


  1. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst, 2007. 99(6):433-41.
  2. Wong, SL. Lymph node counts and survival rates after resection for colon and rectal cancer. Gastrointest Cancer Res 2009 Mar–Apr;3(2 Suppl 1):S33–S35.
  3. Compton CC, Fielding PL, Burgart LJ, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000 Jul;124(7):979–942.