Preserving NLST mortality benefits and acceptable morbidity for lung cancer surgery in a community hospital.

Autor: Jacobson FL; Division of Thoracic Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Dezube AR; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Bravo-Iñiguez C; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kucukak S; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Bay CP; Division of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Wee JO; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Coppolino AA 3rd; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Jaklitsch MT; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Ducko CT; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2021 Jul; Vol. 124 (1), pp. 124-134. Date of Electronic Publication: 2021 Apr 12.
DOI: 10.1002/jso.26483
Abstrakt: 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.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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