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Preserving NLST mortality benefits and acceptable morbidity for lung cancer surgery in a community hospital
Author(s) -
Jacobson Francine L.,
Dezube Aaron R.,
Bravoiñiguez Carlos,
Kucukak Suden,
Bay Camden P.,
Wee Jon O.,
Coppolino Antonio A.,
Jaklitsch Michael T.,
Ducko Christopher T.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26483
Subject(s) - medicine , interquartile range , lung cancer , stage (stratigraphy) , national lung screening trial , retrospective cohort study , lung cancer screening , occult , radiology , surgery , paleontology , alternative medicine , pathology , biology
Abstract Background and Objectives The aim of this study was to demonstrate whether academic thoracic surgeons could achieve morbidity and mortality rates in community hospitals equivalent to those seen in National Lung Screening Trial (NLST). Methods This was a retrospective review of community hospital lung cancer procedures for clinical Stage I–III non‐small‐cell lung cancers from 2007 through 2014. Variables include age, comorbidities, computed tomography (CT) characterization, and operative techniques. Results There were 177 patients who had lung cancers removed by a minimally invasive approach (79%), including lobectomy in 127 (72%), segmentectomy in 4 (2%), and wedge‐resections in 46 (26%). The median patient age was 71 years (interquartile range [IQR], 63–76). The cohort was primarily female (58%), clinical Stage I (82%), with a median tumor size of 2.3 cm (IQR, 1.5–3.3). The median length of stay was 6 days (range: 1–35). Complications were experienced by 78 (44.1%) patients, most commonly atrial fibrillation in 20 (11.3%) followed by air‐leak in 19 (10.7%). There were no in‐hospital deaths. Tumor location and extent of resection were associated with complications, while larger tumor size, margin contour, and resection method were associated with air‐leak (all p < 0.05). Higher clinical stage and larger tumor size were associated with occult Stage III disease (both p < 0.05). Conclusions The low morbidity and mortality rates from the NLST were achievable in a community setting for early‐stage lung cancer. Characterization of cancers using CT imaging identified factors most commonly associated with postoperative complications and the presence of occult Stage III disease.