Peri- and postoperative management of stage I–III Non Small Cell Lung Cancer: Which quality of care indicators are evidence-based?

Oncologic Quality Indicators in Thoracic Surgery

“…Both strategies identified factors such as hospital size or teaching status, surgeon specialty, and access to multi-disciplinary care teams as significant contributors to favorable oncologic outcomes. Surgeon or hospital procedural volume was not clearly related to postoperative mortality, as discussed elsewhere in this issue 3 . However, as this chapter focuses on measures that lend themselves to easier targeted intervention, these structural measures will not be addressed further.…”

“…Instead, they recommended 12 evidence-based and 5 consensus-based process and outcomes measures related to preoperative assessment, pathologic staging and evaluation, surgical resection, and adjuvant therapy 2 . Subsequently, Numan et al used the Donabedian framework for two systematic reviews to identify supported indicators for quality pre- and post-operative care for stage I–IIIA NSCLC 3, 4 . Both strategies identified factors such as hospital size or teaching status, surgeon specialty, and access to multi-disciplinary care teams as significant contributors to favorable oncologic outcomes.…”

“…While some nuances remain, complete (R0) anatomic resection, when feasible, is considered the standard of care 2, 3, 20–22 . Similarly, minimally invasive approaches should be undertaken when feasible as they correlate with shorter length of stay, improved pain control, though variable LN assessment despite similar overall survival 4, 20, 22, 23 .…”

“…When compared to systematic sampling, lymphadenectomy/lymph node dissection for stage I–IIIA NSCLC identified more N2 disease but was not associated with improved survival. Therefore, systematic sampling is likely sufficient 3, 26 .…”

“…The elements of such standardized care pathways can be seen in Table 5 and correlate with decreased length of stay, fewer pulmonary complications, and improved pain control. Specifically, several randomized control trials demonstrated improved pain control with preemptive epidural analgesia or nerve block and decreased air leaks with chest tubes managed on water seal 3 . Implementation of a clinical care pathway for NSCLC can lead to widespread improved performance on quality metrics 31 .…”