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Nobel TB, Tan KS, Adusumilli PS, Bains MS, Downey RJ, Gray K, Huang J, Isbell JM, Molena D, Park BJ, Rocco G, Rusch VW, Sihag S, Jones DR, Bott MJ. Outcomes of Patients Undergoing Segmentectomy for Occult Node-Positive Clinical Stage IA Lung Cancer. Ann Thorac Surg 2024; 118:655-663. [PMID: 38866198 PMCID: PMC11347119 DOI: 10.1016/j.athoracsur.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/03/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Results of recent clinical trials suggest that segmentectomy may be an acceptable alternative to lobectomy for selected patients with early-stage non-small cell lung cancer (NSCLC). Increased use of segmentectomy may result in a concomitant increase in occult node-positive (N+) disease on surgical pathology examination. The optimal management for such patients remains unknown. METHODS Clinicopathologic data were abstracted from a prospective institutional database to identify patients with pathologic N+ disease after segmentectomy for cT1 N0 M0 NSCLC. Propensity score matching identified a comparable lobectomy cohort for assessment of cumulative incidence of recurrence and overall survival (OS). RESULTS Of 759 included patients, 27 (4%) had nodal upstaging on the final pathology report. Of these 27 patients, 4 (15%) had skip metastasis to N2 stations, and 20 (74%) received adjuvant therapy; no completion lobectomies were performed. Ten patients (37%) had disease recurrence: 3 isolated locoregional (11%) and 7 distant (26%). The median time to recurrence among patients with recurrence was 1.8 years; OS after recurrence was 3.4 years. After 5:1 matching with 109 patients who underwent lobectomy, all variables were balanced between the groups, except pathologic N2 stage and open surgical approach. The 5-year cumulative incidence of recurrence was not significantly different between segmentectomy and lobectomy (42% vs 52%, respectively; Gray's P = .1). The 5-year OS (63% and 50%) and rate of locoregional recurrence (12% vs 13%) were not statistically different between the groups. CONCLUSIONS Patients with occult N+ disease after segmentectomy for cT1 N0 M0 NSCLC had limited isolated locoregional recurrences and outcomes similar to those in patients who underwent lobectomy. Lobectomy may not provide an advantage in these patients.
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Affiliation(s)
- Tamar B Nobel
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Biostatics Division, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine Gray
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Campos JH. The Society of Thoracic Surgeons General Thoracic Surgery Database: A Unique Society on Quality Healthcare and Outcomes. J Cardiothorac Vasc Anesth 2024; 38:1845-1847. [PMID: 38918092 DOI: 10.1053/j.jvca.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 06/27/2024]
Affiliation(s)
- Javier H Campos
- Executive Medical Director Perioperative Services, Roy and Lucille Carver College of Medicine, University of Iowa Health Care, Iowa City, IA
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Watkins AA, Rizvi TZ, Lopez E, Shehata D, Ssemaganda H, Lin Z, Stock CT, Moffatt-Bruce SD, Servais EL. Trends and comparative outcomes between operative approaches for segmentectomy in lung cancer. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00605-6. [PMID: 39002852 DOI: 10.1016/j.jtcvs.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Segmentectomy is increasingly performed for non-small cell lung cancer. However, comparative outcomes data among open, robotic-assisted, and video-assisted thoracoscopic approaches are limited. METHODS A retrospective cohort study of non-small cell lung cancer segmentectomy cases (2013-2021) from the Society of Thoracic Surgeons General Thoracic Surgery Database was performed. Baseline characteristics were balanced using inverse probability of treatment weighting and compared by operative approach. Volume trends, outcomes, and nodal upstaging were assessed. RESULTS Of 9927 patients who underwent segmentectomy, 84.8% underwent minimally invasive surgery, with robotic-assisted thoracoscopic surgery becoming the most common approach in 2019. Open segmentectomy is more likely to be performed at low-volume centers (P < .0001), whereas robotic-assisted thoracoscopic surgery is more likely to be performed at high-volume centers (P < .0001). Video-assisted thoracoscopic surgery had a higher open conversion rate than robotic-assisted thoracoscopic surgery (odds ratio, 11.8; CI, 7.01-21.6; P < .001). Minimally invasive surgery had less 30-day morbidity compared with open segmentectomy (video-assisted thoracoscopic surgery odds ratio, 0.71; 95% CI, 0.55-0.94; P = .013; robotic-assisted thoracoscopic surgery odds ratio, 0.59; CI, 0.43-0.81; P = .001). The number of nodes and stations harvested were highest for robotic-assisted thoracoscopic surgery; however, N1 upstaging was more likely in open compared with robotic-assisted thoracoscopic surgery (odds ratio, 0.63; CI, 0.45-0.89; P < .007) and video-assisted thoracoscopic surgery (odds ratio, 0.61; CI, 0.46-0.83; P = .001). CONCLUSIONS Segmentectomy volume has increased considerably, with robotic-assisted thoracoscopic surgery becoming the most common approach. Minimally invasive surgery has less major morbidity compared with open segmentectomy, with no difference between video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery. However, risk of open conversion is higher with video-assisted thoracoscopic surgery. Robotic-assisted thoracoscopic surgery had increased nodal harvest, whereas hilar nodal upstaging was highest with thoracotomy. This study reveals significant differences in outcomes exist between segmentectomy operative approach; the impact of approach on survival merits further investigation.
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Affiliation(s)
- Ammara A Watkins
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass; Department of Surgery, Tufts University School of Medicine, Boston, Mass
| | - Tasneem Z Rizvi
- Department of Surgery, Tufts University School of Medicine, Boston, Mass; Department of Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Edilin Lopez
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Dena Shehata
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Henry Ssemaganda
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Zhibang Lin
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Cameron T Stock
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass; Department of Surgery, Tufts University School of Medicine, Boston, Mass
| | - Susan D Moffatt-Bruce
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass; Department of Surgery, Tufts University School of Medicine, Boston, Mass; Department of Surgery, UMass Chan Medical School, Worcester, Mass
| | - Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass; Department of Surgery, Tufts University School of Medicine, Boston, Mass; Department of Surgery, UMass Chan Medical School, Worcester, Mass.
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4
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Towe CW, Servais EL, Brown LM, Blasberg JD, Mitchell JD, Worrell SG, Seder CW, David EA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2023 Update on Outcomes and Research. Ann Thorac Surg 2024; 117:489-496. [PMID: 38043852 DOI: 10.1016/j.athoracsur.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) continues its trajectory of growth and enhancement, solidifying its stature as a premier global thoracic surgical database. The past year witnessed a notable expansion with the inclusion of 10 additional participating sites, now totaling 287, augmenting the database's repository to more than 800,000 procedures. A significant stride was made in refining the data audit process, thereby elevating the accuracy and completeness metrics, a testament to the relentless pursuit of data integrity. The GTSD further broadened its research apparatus, with 15 scholarly publications, a 50% uptick from the preceding year. These publications underscore the database's instrumental role in advancing thoracic surgical knowledge. In a concerted effort to alleviate data entry exigencies, the GTSD Task Force also instituted streamlined data submission protocols, a move lauded by participant sites. This report delineates the recent advancements, volume trajectories, and outcome metrics and encapsulates the prolific research output emanating from the GTSD, reflecting a year of substantial progress and academic fecundity.
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Affiliation(s)
- Christopher W Towe
- Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts; Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Lisa M Brown
- Section of General Thoracic Surgery, UC Davis Health, Sacramento, California
| | - Justin D Blasberg
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
| | | | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth A David
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
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Matsuoka S, Eguchi T, Seshimoto M, Mishima S, Hara D, Kumeda H, Miura K, Hamanaka K, Shimizu K. Segmentectomy-oriented anatomical model for enhanced precision surgery of the left upper lobe. JTCVS Tech 2024; 23:92-103. [PMID: 38352002 PMCID: PMC10859669 DOI: 10.1016/j.xjtc.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To optimize surgical outcomes and minimize complications in complex segmentectomy of the left upper lobe, we investigated the topographical anatomy of the left upper lobe and developed a segmentectomy-oriented anatomical model. Methods A state-of-the-art 3-dimensional computed tomography workstation was used to visualize the intersegmental planes and associated veins to categorize the anatomical patterns influencing surgical procedures during left upper lobe segmentectomy. This included the central vein affecting S1+2 (apicoposterior segment) segmentectomy, the transverse S3 (anterior segment) affecting S3 segmentectomy, and other venous branching patterns in 395 patients who underwent thoracic surgery at our institution. Results The central vein was observed in 32% of the patients, necessitating access from the interlobar area after segmental artery and bronchus division. Transverse S3 incidence was 27%, revealing that only one-third of the patients required complete left upper lobe transection between S4 and S3 during S3 segmentectomy. A significant negative correlation was observed between the presence of transverse S3 and the central vein (<10% of patients with the central vein had transverse S3 and vice versa). In 6% of patients, the lingular segmental veins partially or entirely drained into the inferior pulmonary vein, potentially causing excessive or insufficient resection during surgery. Conclusions This study offers valuable insights into the topographic anatomy of the left upper lobe and presents a segmentectomy-oriented anatomical model for complex segmentectomies. Our approach enables a more precise and individualized surgical planning for patients undergoing segmentectomy based on their unique anatomy, which could thereby lead to improved patient outcomes.
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Affiliation(s)
- Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Maho Seshimoto
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shuji Mishima
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Daisuke Hara
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hirotaka Kumeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Pezeshkian F, McAllister M, Singh A, Theeuwen H, Abdallat M, Figueroa PU, Gill RR, Kim AW, Jaklitsch MT. What's new in thoracic oncology. J Surg Oncol 2024; 129:128-137. [PMID: 38031889 DOI: 10.1002/jso.27535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Many changes have occurred in the field of thoracic surgery over the last several years. In this review, we will discuss new diagnostic techniques for lung cancer, innovations in surgery, and major updates on latest treatment options including immunotherapy. All these have significantly started to change our approach toward the management of lung cancer and have great potential to improve the lives of our patients afflicted with this disease.
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Affiliation(s)
- Fatemehsadat Pezeshkian
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Miles McAllister
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anupama Singh
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hailey Theeuwen
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mohammad Abdallat
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paula Ugalde Figueroa
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Brunelli A, Decaluwe H, Gonzalez M, Gossot D, Petersen RH, Augustin F, Assouad J, Baste JM, Batirel H, Falcoz PE, Almanzar SF, Furak J, Gomez-Hernandez MT, de Antonio DG, Hansen H, Jimenez M, Koryllos A, Meacci E, Opitz I, Pages PB, Piwkowski C, Ruffini E, Schneiter D, Stupnik T, Szanto Z, Thomas P, Toker A, Tosi D, Veronesi G. European Society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer. Eur J Cardiothorac Surg 2023; 63:ezad224. [PMID: 37267148 DOI: 10.1093/ejcts/ezad224] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Michel Gonzalez
- Department of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Dominique Gossot
- Department of Thoracic Surgery, IMM-Curie-Montsouris Thoracic Institute, Paris, France
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jalal Assouad
- Department of Thoracic Surgery. Tenon Hospital, Sorbonne University-Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean Marc Baste
- Department of Cardio-Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Hasan Batirel
- Department of Thoracic Surgery, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | | | | | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - David Gomez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Henrik Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marcelo Jimenez
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Aris Koryllos
- Department of Thoracic Surgery, Florence Nightingale Hospital, Duesseldorf, Germany
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Catholic University of Sacred Hearth, Rome, Italy
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Cezary Piwkowski
- Thoracic Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Enrico Ruffini
- Division of Thoracic Surgery, University of Torino, Turin, Italy
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tomaz Stupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Zalan Szanto
- Department of Thoracic Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Pascal Thomas
- Department of Thoracic Surgery, North Hospital, APHM/Aix-Marseille University, Marseille, France
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Veronesi
- Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
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8
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Logan CD, Jacobs RC, Feinglass J, Lung K, Kim S, Bharat A, Odell DD. National trends in the quality of segmentectomy for lung cancer. J Thorac Cardiovasc Surg 2023; 165:351-363.e20. [PMID: 36088143 PMCID: PMC9771936 DOI: 10.1016/j.jtcvs.2022.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Segmentectomy has become an accepted procedure for the treatment of non-small cell lung cancer. Adequate lymph node sampling, sufficient margins, and proper tumor size selection are factors vital for achieving outcomes comparable to lobectomy. Previous studies have demonstrated poor adherence to lymph node sampling guidelines. However, national trends in the quality of segmentectomy and implications on survival are unknown. METHODS The National Cancer Database was used to identify patients with clinical stage I to IIA non-small cell lung cancer surgically treated between 2004 and 2018. Facility-level trends in extent of resection and segmentectomy odds of adherence to (1) 2014 Commission on Cancer guidelines of sampling 10 or more lymph nodes, (2) negative (R0) resection margins, and (3) tumor size 2 cm or less were determined. Propensity score matching was based on segmentectomy adherence to (4) a composite of all measures, and survival was evaluated with Cox models and Kaplan-Meier survival estimates. RESULTS The study included 249,391 patients with 4.4% (n = 11,006) treated with segmentectomy. The proportion of segmentectomies performed annually increased from 3.3% in 2004 to 6.1% in 2018 (P < .001). Overall, 12.6% (n = 1385) of patients who underwent segmentectomy between 2004 and 2018 were adherent to all measures, and adherence was more likely at academic programs (odds ratio, 1.56; 95% confidence interval, 1.14-2.15) than nonacademic programs (P < .001, reference). Adherence to all measures was associated with improved survival (hazard ratio, 0.67; 95% confidence interval, 0.56-0.79). CONCLUSIONS As segmentectomy is increasingly established as a valid oncological option for the treatment of non-small cell lung cancer, it is important that quality remains high. This study demonstrates that continued improvement is needed.
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Affiliation(s)
- Charles D Logan
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Ryan C Jacobs
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Joe Feinglass
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Kalvin Lung
- Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Samuel Kim
- Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Ankit Bharat
- Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - David D Odell
- Department of Surgery, Surgical Outcomes and Quality Improvement Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill; Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Ill.
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9
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Servais EL, Blasberg JD, Brown LM, Towe CW, Seder CW, Onaitis MW, Block MI, David EA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2022 Update on Outcomes and Research. Ann Thorac Surg 2023; 115:43-49. [PMID: 36404445 DOI: 10.1016/j.athoracsur.2022.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 12/31/2022]
Abstract
The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) remains the largest and most robust thoracic surgical database in the world. Participating sites receive risk-adjusted performance reports for benchmarking and quality improvement initiatives. The GTSD also provides several mechanisms for high-quality clinical research using data from 274 participant sites and 781,000 procedures since its inception in 2002. Participant sites are audited at random annually for completeness and accuracy. Over the last year and a half, the GTSD Task Force continued to refine the data collection process, implementing an updated data collection form in July 2021, ensuring high data fidelity while minimizing data entry burden. In addition, the STS Workforce on National Databases has supported a robust GTSD-based research program, which led to eight scholarly publications in 2021. This report provides an update on volume trends, outcomes, and database initiatives as well as a summary of research productivity resulting from the GTSD over the preceding year.
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Affiliation(s)
- Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts.
| | - Justin D Blasberg
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Lisa M Brown
- Section of General Thoracic Surgery, UC Davis Health, Sacramento, California
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mark W Onaitis
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, California
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
| | - Elizabeth A David
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
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10
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Gelzinis TA. Pulmonary Segmentectomy: A New Standard of Care in Patients with Non-Small Cell Cancer. J Cardiothorac Vasc Anesth 2022; 36:3987-3989. [PMID: 35933274 DOI: 10.1053/j.jvca.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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11
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Trends in segmentectomy for the treatment of stage 1A non-small cell lung cancers: Does the robot have an impact? Am J Surg 2022; 225:921-926. [PMID: 36384986 DOI: 10.1016/j.amjsurg.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/02/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Lobectomy may unnecessarily resect healthy lung parenchyma in Stage 1A non-small cell lung cancers (NSCLC). Segmentectomies may provide a lung-sparing option. VATS segmentectomies can be technically challenging; robotics may have features that provide advantages in performing segmentectomies. We describe the association of the robot on national trends in segmentectomies. METHODS The National Cancer Database (2010-2017) was queried for patients with Stage 1A NSCLC who underwent lobectomies and segmentectomies. The proportion of segmentectomies vs. lobectomies and the proportion of robotic vs. VATS segmentectomies was calculated annually. RESULTS The proportion of segmentectomies increased compared to lobectomies for all surgical approaches but remained constant for minimally-invasive approaches. The proportion of robotic segmentectomies increased over the years compared to VATS segmentectomies. Descriptive statistics are reported as numbers and proportions. Trends in the proportions of lobectomies and segmentectomies were compared using Chi-squared test for categorical variables and unpaired t-test for independent means. A p-value of <0.05 was considered statistically significant. Statistical analysis was performed using SPSS Statistics Software version 24 (IBM Corp, Armonk, NY). CONCLUSIONS We demonstrate an increasing trend and proportion of robotic segmentectomies being performed in comparison to VATS segmentectomies. The robotic platform may facilitate the performance of more segmentectomies for early-stage NSCLC. STATISTICAL ANALYSIS
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Chikwe J. Editor's Choice: Critical Times for Coronary Revascularization Guidelines. Ann Thorac Surg 2022; 113:1061-1064. [PMID: 35346446 DOI: 10.1016/j.athoracsur.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Dezube AR, Hirji S, Shah R, Axtell A, Rodriguez M, Swanson S, Jaklitsch MT, Mody GN. Pre-COVID19 National Mortality Trends in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancer. J Surg Res 2022; 274:213-223. [DOI: 10.1016/j.jss.2021.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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