Elsevier

The Annals of Thoracic Surgery

Volume 80, Issue 6, December 2005, Pages 2051-2056
The Annals of Thoracic Surgery

Original article
General thoracic
Patterns of Surgical Care of Lung Cancer Patients

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
https://doi.org/10.1016/j.athoracsur.2005.06.071Get rights and content

Background

This survey was performed to determine the patterns of surgical care provided patients with non-small cell lung carcinoma (NSCLC).

Methods

In 2001, the American College of Surgeons carried out a patient care survey of 729 hospitals to retrieve information of NSCLC patients’ history, evaluation, pathology, and surgical treatment.

Results

Inclusion criteria were met by 40,090 patients: of whom 11,668 (29.1%) were treated surgically; 74.2% alone and 25.8% as part of multimodality therapy. Of these patients, 59.5% were in stage I, 17.5% in stage II, 17.0% in stage III, and 6.0% in stage IV. Surgery patient demographics were the following: 55% male and 45% female; 46.8% 70 years or older; and 76.3% had significant comorbidities. Tumor characteristics: squamous 28%, adenocarcinoma 37.6%, other 34.4%. Staging: in addition to radiologic examinations, preoperative mediastinoscopy was performed in 27.1% of operated patients with node biopsy in only 46.6% of these procedures. Operations: wedge resection 15.6%, lobectomy 70.8%, pneumonectomy 13.6%. Surgical margins were positive in 7.8%, but only 65.2% had frozen section analysis. Perioperative mortality was 5.2%, but was 4.0% in nontransfused patients and 12.7% in transfused patients and was 3.2% in high-volume (more than 90 operations per year) versus 4.8% in low-volume hospitals (p < 0.001).

Conclusions

(1) Patients being operated for NSCLC are elderly with significant comorbid conditions. (2) More patients than previously are female and have adenocarcinoma. (3) Mediastinoscopy is infrequently performed and lymph nodes are biopsied in less than 50% of them. (4) Lobectomy is the most common operation, and positive surgical margins are too frequent. (5) Operative mortality is reasonable but transfusion is a marker for increased risk and outcomes are superior in high-volume hospitals. (6) Hospitals with higher volume had fewer perioperative deaths.

Section snippets

Material and Methods

A total of 729 hospitals participated in the PCE study of NSCLC patients, diagnosed between January 1, 2001 and December 31, 2001. All geographic regions were included. As fully defined elsewhere [2], there were four cancer program categories: community cancer centers, comprehensive community cancer centers, teaching-research facilities, and other. A total of 40,909 cases met the inclusion criteria of microscopically confirmed primary NSCLC, classified topographically as C34.0, C34.1, C34.2,

Results

The survey identified a total of 40,090 patients who met inclusion criteria. The analysis of the entire PCE population is currently under review [9]. This manuscript addresses the 11,668 patients (29.1% of the total) whose initial management included surgical therapy. There were 279 hospitals classified as community cancer centers with 2,609 (22.4%) patients; 266 were comprehensive community cancer centers with 5,359 (46.0%) patients and 141 were teaching/research hospitals with 3,649 (31.3%)

Comment

The CCACS PCE process that sponsored this study was not hypothesis driven. The PCE is designed to determine simply what is being done in hospitals. There is no access to physician information and these data represent only a single year in time and thus do not permit long-term follow-up analysis. However, as with previous PCEs, there is utility to identifying patterns of patients, their disease, and hospital care. First is simply tracking this information to identify and allow reaction to

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