Colon cancer care provides an important opportunity to identify how providers and policymakers can achieve high quality outcomes in the context of quality guidelines. Among patients surgically treated for colon cancer, better survival has been demonstrated in those with more lymph nodes evaluated. Evaluated at the time of surgery, lymph node involvement (i.e. node positive disease) indicates advanced disease among colon cancer patients and a recommendation for adjuvant chemotherapy. Over the past 20 years, several practice organizations and consensus panels have identified the surgical evaluation of 12 or more lymph nodes as an important quality indicator for appropriate staging and treatment of newly diagnosed colon cancer patients. However, the exact mechanism behind more extensive lymph node evaluation and improved survival remains contentious. Using the Surveillance, Epidemiology and End Results (SEER) data and the SEER-Medicare data, which combines a set of cancer registry data linked to Medicare administrative claims, this research evaluates current gaps in knowledge surrounding the achievement and impact of lymph node quality guidelines for colon cancer care by l) further evaluating the mechanism between lymph node evaluation and survival 2) identifying whether high quality comprehensive care might account for this relationship and 3) understanding how to significantly improve guideline adherence among providers of colon cancer care. Overall, this research provides timely evidence for future guideline recommendations surrounding the relative impact of lymph node evaluation for colon cancer care.