Raymond U Osarogiagbon1, Matthew P Smeltzer2, Nicholas R Faris3, Meredith A Ray2, Carrie Fehnel4, Phillip Ojeabulu4, Olawale Akinbobola4, Meghan Meadows-Taylor2, Laura M McHugh5, Ahmed M Halal6, Paul Levy7, Vishal Sachdev8, David Talton8, Lynn Wiggins9, Xiao-Ou Shu10, Yu Shyr11, Edward T Robbins5, Lisa M Klesges12. 1. Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. Electronic address: rosarogi@bmhcc.org. 2. Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee; Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee. 3. Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. 4. Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee. 5. Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. 6. Department of Cardiothoracic Surgery, North-East Arkansas Baptist Memorial Hospital, Jonesboro, Arkansas. 7. Department of Cardiothoracic Surgery, Baptist Memorial Hospital-North Mississippi, Oxford, Mississippi. 8. Department of Cardiothoracic Surgery, North Mississippi Medical Center, Tupelo, Mississippi. 9. Department of Surgery, St. Bernard's Regional Medical Center, Jonesboro, Arkansas. 10. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 11. Department of Biostatistics, Vanderbilt Ingram Cancer Center, Nashville, Tennessee. 12. Department of Surgery, Washington University, St. Louis, Missouri.
Abstract
INTRODUCTION: Suboptimal pathologic nodal staging prevails after curative-intent resection of lung cancer. We evaluated the impact of a lymph node specimen collection kit on lung cancer surgery outcomes in a prospective, population-based, staggered implementation study. METHODS: From January 1, 2014, to August 28, 2018, we implemented the kit in three homogeneous institutional cohorts involving 11 eligible hospitals from four contiguous hospital referral regions. Our primary outcome was pathologic nodal staging quality, defined by the following evidence-based measures: the number of lymph nodes or stations examined, proportions with poor-quality markers such as nonexamination of lymph nodes, and aggregate quality benchmarks including the National Comprehensive Cancer Network criteria. Additional outcomes included perioperative complications, health care utilization, and overall survival. RESULTS: Of 1492 participants, 56% had resection with the kit and 44% without. Pathologic nodal staging quality was significantly higher in the kit cases: 0.2% of kit cases versus 9.8% of nonkit cases had no lymph nodes examined; 3.2% versus 25.3% had no mediastinal lymph nodes; 75% versus 26% attained the National Comprehensive Cancer Network criteria (p < 0.0001 for all comparisons). Kit cases revealed no difference in perioperative complications or health care utilization except for significantly shorter duration of surgery, lower proportions with atelectasis, and slightly higher use of blood transfusion. Resection with the kit was associated with a lower hazard of death (crude, 0.78 [95% confidence interval: 0.61-0.99]; adjusted 0.85 [0.71-1.02]). CONCLUSIONS: Lung cancer surgery with a lymph node collection kit significantly improved pathologic nodal staging quality, with a trend toward survival improvement, without excessive perioperative morbidity or mortality.
INTRODUCTION: Suboptimal pathologic nodal staging prevails after curative-intent resection of lung cancer. We evaluated the impact of a lymph node specimen collection kit on lung cancer surgery outcomes in a prospective, population-based, staggered implementation study. METHODS: From January 1, 2014, to August 28, 2018, we implemented the kit in three homogeneous institutional cohorts involving 11 eligible hospitals from four contiguous hospital referral regions. Our primary outcome was pathologic nodal staging quality, defined by the following evidence-based measures: the number of lymph nodes or stations examined, proportions with poor-quality markers such as nonexamination of lymph nodes, and aggregate quality benchmarks including the National Comprehensive Cancer Network criteria. Additional outcomes included perioperative complications, health care utilization, and overall survival. RESULTS: Of 1492 participants, 56% had resection with the kit and 44% without. Pathologic nodal staging quality was significantly higher in the kit cases: 0.2% of kit cases versus 9.8% of nonkit cases had no lymph nodes examined; 3.2% versus 25.3% had no mediastinal lymph nodes; 75% versus 26% attained the National Comprehensive Cancer Network criteria (p < 0.0001 for all comparisons). Kit cases revealed no difference in perioperative complications or health care utilization except for significantly shorter duration of surgery, lower proportions with atelectasis, and slightly higher use of blood transfusion. Resection with the kit was associated with a lower hazard of death (crude, 0.78 [95% confidence interval: 0.61-0.99]; adjusted 0.85 [0.71-1.02]). CONCLUSIONS: Lung cancer surgery with a lymph node collection kit significantly improved pathologic nodal staging quality, with a trend toward survival improvement, without excessive perioperative morbidity or mortality.
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