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

• Published in: Journal of surgical oncology 2021-07, Vol.124 (1), p.124-134
• Main Authors: Jacobson, Francine L., Dezube, Aaron R., Bravo‐iñiguez, Carlos, Kucukak, Suden, Bay, Camden P., Wee, Jon O., Coppolino, Antonio A., Jaklitsch, Michael T., Ducko, Christopher T.
• Format: Article
• Language: English
• Subjects: Cancer surgery; community care network; computed tomography; diagnostic imaging; Lung cancer; lung cancer morbidity and mortality; Medical imaging; Morbidity; Mortality; NLST; video‐assisted thoracoscopic surgery
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.26483

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