TY - JOUR
T1 - Outcomes After Use of a Lymph Node Collection Kit for Lung Cancer Surgery
T2 - A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study
AU - Osarogiagbon, Raymond U.
AU - Smeltzer, Matthew P.
AU - Faris, Nicholas R.
AU - Ray, Meredith A.
AU - Fehnel, Carrie
AU - Ojeabulu, Phillip
AU - Akinbobola, Olawale
AU - Meadows-Taylor, Meghan
AU - McHugh, Laura M.
AU - Halal, Ahmed M.
AU - Levy, Paul
AU - Sachdev, Vishal
AU - Talton, David
AU - Wiggins, Lynn
AU - Shu, Xiao Ou
AU - Shyr, Yu
AU - Robbins, Edward T.
AU - Klesges, Lisa M.
N1 - Publisher Copyright:
© 2021 International Association for the Study of Lung Cancer
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Lymph node specimen collection kit
KW - Lymphadenectomy
KW - Nodal staging
KW - Quality of surgical care
KW - Surgical resection
UR - http://www.scopus.com/inward/record.url?scp=85102271895&partnerID=8YFLogxK
U2 - 10.1016/j.jtho.2020.12.025
DO - 10.1016/j.jtho.2020.12.025
M3 - Article
C2 - 33607311
AN - SCOPUS:85102271895
SN - 1556-0864
VL - 16
SP - 630
EP - 642
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 4
ER -