A pilot quality improvement initiative for lymph node dissection during lung cancer surgery

To evaluate the impact of a quality improvement initiative on intraoperative lymph node (LN) dissection adequacy. A single-centre cohort of 781 naïve patients who underwent resection of non-small cell lung cancer with pathological LN involvement and survived beyond 90 days was reviewed. LN dissectio...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2024-11, Vol.66 (6)
Main Authors: Thomas, Pascal Alexandre, Braggio, Cesare, Fourdrain, Alex, Vasse, Matthieu, Brioude, Geoffrey, Trousse, Delphine, Boulate, David, Dales, Jean-Philippe, Doddoli, Christophe, Tomasini, Pascale, D'journo, Xavier Benoît, Greillier, Laurent
Format: Article
Language:English
Subjects:
Aged
Carcinoma, Non-Small-Cell Lung - pathology
Carcinoma, Non-Small-Cell Lung - surgery
Disease-Free Survival
Female
Humans
Lung Neoplasms - pathology
Lung Neoplasms - surgery
Lymph Node Excision - methods
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Male
Middle Aged
Pilot Projects
Pneumonectomy - methods
Quality Improvement
Retrospective Studies
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Summary:To evaluate the impact of a quality improvement initiative on intraoperative lymph node (LN) dissection adequacy. A single-centre cohort of 781 naïve patients who underwent resection of non-small cell lung cancer with pathological LN involvement and survived beyond 90 days was reviewed. LN dissection metrics were compared before and after the implementation of a quality improvement initiative. Quality metrics (QM) were: QM1 (≥10 LN examined), QM2 (≥3 intrapulmonary and hilar LN, ≥ 3 mediastinal stations, including station 7 in all cases), and QM3 (combination of QM1 and QM2). The proportion of patients meeting QM1 did not differ significantly between the pre- (87.8%) and post-implementation (89.1%) periods. However, meeting QM2 and QM3 significantly improved from 79.5% to 88.6% (P = 0.001), and 76.2% to 84.4% (P = 0.007), respectively. Cox proportional hazard regression model for disease-free survival showed that patients operated on after the implementation of the quality improvement initiative exhibited better disease-free survival compared to those operated on before [adjusted hazard ratio (aHR): 0.73; 95% confidence interval (CI) 0.59-0.90; P = 0.003]. Nevertheless, none of these quality metrics influenced long-term outcomes. In contrast, adjuvant chemotherapy (aHR: 0.55; 95% CI 0.43-0.71; P 
ISSN:1873-734X
1873-734X
DOI:10.1093/ejcts/ezae438