Surgeon Specialty and Long-Term Survival After Pulmonary Resection for Lung Cancer

Farjah, Farhood; Flum, David R.; Varghese, Thomas K.; Symons, Rebecca; Wood, Douglas E.

doi:10.1016/j.athoracsur.2008.12.030

Cited by 149 publications

(99 citation statements)

References 28 publications

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“…Previous studies of the Nationwide Inpatient Sample and SEER-Medicare databases have established improved perioperative and overall survival in patients with NSCLC treated by general thoracic or cardiothoracic surgeons (28,29). Further, it is well established that long-term survival is improved in patients treated by cancer specialists (30, 31).…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Risk Factors for Long-Term Mortality after Pulmonary Resection for Lung Cancer: An Analysis of More than 90,000 Patients from the National Cancer Data Base

Khullar

Gillespie

Nickleach

et al. 2015

Journal of the American College of Surgeons

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Background Several clinical variables, such as tumor stage and age, are well-established factors associated with long-term survival following surgical resection of lung cancer. Our aim was to examine the impact of other clinical and demographic variables, controlling for known predictors of long-term survival, in order to investigate how outcomes varied according to important non-clinical factors. Study Design The National Cancer Data Base, jointly supported by the Commission on Cancer of the American College of Surgeons and the American Cancer Society, was utilized to identify patients undergoing pulmonary resection for lung cancer and perform a retrospective cohort study. The cohort consisted of patients diagnosed with NSCLC from 2003–2006 who underwent resection, as overall survival data are available only for patients diagnosed through 2006. A Cox proportional hazards survival model was used to examine factors associated with risk of mortality. Results A total of 92,929 patients were identified as diagnosed during the study period and undergoing surgical resection for lung cancer. On multivariable analysis, several socioeconomic factors such as lack of insurance, lower income, less education, and treatment at community centers vs. academic/research programs predicted worse overall survival after controlling for disease characteristics known to be predictors of worse survival, such as tumor stage, histology, age, and extent of resection. Conclusions Diminished long-term survival after pulmonary resection was associated with a number of socioeconomic factors. To date, this represents the largest database analysis of long-term mortality in patients undergoing surgical resection for lung cancer. The disparities in survival outcomes reported here require further, detailed investigation.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic Risk Factors for Long-Term Mortality after Pulmonary Resection for Lung Cancer: An Analysis of More than 90,000 Patients from the National Cancer Data Base

Khullar

Gillespie

Nickleach

et al. 2015

Journal of the American College of Surgeons

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“…Short-term postoperative risk has also been linked with surgeon case-volume, training and clinical experience [6,8,11–13]. The utility of volume-based structural measures for corrective intervention is limited, and the validity of the volume-outcome relationship has been questioned [15,16].…”

Section: Commentmentioning

confidence: 99%

Risk-Adjusted Margin Positivity Rate as a Surgical Quality Metric for Non-Small Cell Lung Cancer

Lin

Smeltzer

Jemal

et al. 2017

The Annals of Thoracic Surgery

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Background Incomplete lung cancer resection connotes poor prognosis, the incidence varies with patient demographic, clinical, and institutional factors. We sought to develop a valid, survival-impactful facility-based surgical quality metric which adjusts for related patient demographic and clinical characteristics. Methods Facilities performing resections for patients diagnosed with stage I-IIIA non-small-cell lung cancer in National Cancer Data Base between 2004-2011 were identified. Multivariate logistic regression modeling was used to estimate the expected number of margin-positive cases by adjusting for patient risk-mix and calculate the observed: expected (O/E) ratio for each facility. Facilities were categorized as outperformers (O/E ratio<1, p<.05), non-outliers (p>.05), and underperformers (O/E ratio>1, p<.05); and their characteristics across performance categories were compared by chi-square tests. Multivariate Cox proportional hazard analyses were conducted, adjusting for patient demographic and clinical characteristics. Results A total of 96,324 patients underwent surgery at 809 facilities. The overall observed margin-positive rate was 4.4%. Sixty-one facilities (8%) were outperformers, 644(80%) were non-outliers, and 104(13%) were underperformers. One-third (36%) of National Cancer Institute-designated facilities, 13% Academic-Comprehensive-Cancer-Programs, 5% Comprehensive-Community-Cancer-Programs, and 13% ‘other’ facilities achieved outperforming status but no Community-Cancer-Programs did. Interestingly, 9% of National Cancer Institute-designated facilities and 11% of Academic-Comprehensive-Cancer-program facilities were underperformers. Adjusting for patient demographic and clinical characteristics, outperformers had a 5-year all-cause hazard ratio of 0.88 (95%CI: 0.85–0.91, p<.0001) compared to non-outliers; and 0.80 (95%CI: 0.77–0.84, p<.0001) compared to underperformers. Conclusions Facility performance in lung cancer surgery can be captured by the risk-adjusted margin- positivity rate, potentially providing a valid quality improvement metric.

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“…Mortality of lobectomy was significantly lower when performed by a thoracic surgeon compared to a general surgeon. The latter finding was confirmed in a more recent study [101]. In another analysis of more than 2000 pulmonary resections, low-volume centres were compared to high-volume institutions.…”

Section: Surgical Quality Controlmentioning

confidence: 66%

Surgical treatment of early-stage non-small-cell lung cancer

Schil

Balduyck

Waele

et al. 2013

European Journal of Cancer Supplements

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Surgical resection remains the standard of care for functionally operable early-stage non-small-cell lung cancer (NSCLC) and resectable stage IIIA disease. The role of invasive staging and restaging techniques is currently being debated, but they provide the largest biopsy samples which allow for precise mediastinal staging. Different types of operative procedures are currently available to the thoracic surgeon, and some of these interventions can be performed by video-assisted thoracic surgery (VATS) with the same oncological results as those by open thoracotomy. The principal aim of surgical treatment for NSCLC is to obtain a complete resection which has been precisely defined by a working group of the International Association for the Study of Lung Cancer (IASLC). Intraoperative staging of lung cancer is of utmost importance to decide on the extent of resection according to the intraoperative tumour (T) and nodal (N) status. Systematic nodal dissection is generally advocated to evaluate the hilar and mediastinal lymph nodes which are subdivided into seven zones according to the most recent 7th tumour-node-metastasis (TNM) classification. Lymph-node involvement not only determines prognosis but also the administration of adjuvant therapy.In 2011, a new multidisciplinary adenocarcinoma classification was published introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications. The role of limited or sublobar resection, comprising anatomical segmentectomy and wide wedge resection, is reconsidered for early-stage lesions which are more frequently encountered with the recently introduced large screening programmes. Numerous retrospective non-randomised studies suggest that sublobar resection may be an acceptable surgical treatment for early lung cancers, also when performed by VATS.More tailored, personalised therapy has recently been introduced. Quality-of-life parameters and surgical quality indicators become increasingly important to determine the short-term and long-term impact of a surgical procedure. International databases currently collect extensive surgical data, allowing more precise calculation of mortality and morbidity according to predefined risk factors. Centralisation of care has been shown to improve results. Evidence-based guidelines should be further developed to provide optimal staging and therapeutic algorithms.

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Surgeon Specialty and Long-Term Survival After Pulmonary Resection for Lung Cancer

Cited by 149 publications

References 28 publications

Socioeconomic Risk Factors for Long-Term Mortality after Pulmonary Resection for Lung Cancer: An Analysis of More than 90,000 Patients from the National Cancer Data Base

Socioeconomic Risk Factors for Long-Term Mortality after Pulmonary Resection for Lung Cancer: An Analysis of More than 90,000 Patients from the National Cancer Data Base

Risk-Adjusted Margin Positivity Rate as a Surgical Quality Metric for Non-Small Cell Lung Cancer

Surgical treatment of early-stage non-small-cell lung cancer

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