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Rodriguez-Quintero JH, Ghanie A, Jindani R, Kamel MK, Zhu R, Vimolratana M, Chudgar NP, Stiles BM. Pneumonectomy for non-small cell lung cancer. A National Cancer Database analysis of geographic and temporal trends, outcomes, and associated factors. Surgery 2024; 176:918-926. [PMID: 38965005 DOI: 10.1016/j.surg.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The circumstances under which pneumonectomy should be performed are controversial. This study aims to investigate national trends in pneumonectomy use to determine which patients, in what geographic areas, and under what clinical circumstances pneumonectomy is performed in the United States. METHODS We queried the National Cancer Database and included all patients undergoing anatomic surgical resection for non-small cell lung cancer (2015-2020). The association between demographic and clinical factors and the use of pneumonectomy were investigated. RESULTS Who: A total of 128,421 patients were identified, of whom 738 (0.6%) underwent pneumonectomy. Those patients were younger (median 65 vs 68 years, P < .001), more often male (59.9% vs 44.9%, P < .001), more likely to be below median income level (44.2% vs 38.6%, P = .002), and more likely to have lower education indicators (53% vs 48.6%, P = .02) than those who underwent other anatomic resections. Notably, there was a decreasing trend in pneumonectomy use during the study period (0.9% down to 0.4%, P < .001). Where: Patients undergoing pneumonectomy were less likely to live in metropolitan areas (77.9% vs 81.7%, P = .008) and to live closer (<12 miles) to their treating facility (45% vs 49%, P = .02). Regional geographic differences also were identified (P < .001). Why: Patients who underwent pneumonectomy were more likely to have received neoadjuvant therapy (20.6% vs 5.3%, P < .001), to be clinically N (+) (39.3% vs 12.3%, P < .001), and to have more advanced tumors (cT3-4: 46.3% vs 11.3%, P < .001). CONCLUSION Although primarily driven by advanced oncologic features, socioeconomic and geographic factors also were associated independently with the use of pneumonectomy. Standardizing pneumonectomy indications nationwide is crucial to prevent widening outcome gaps for patients with lung cancer.
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Affiliation(s)
- Jorge Humberto Rodriguez-Quintero
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. https://www.twitter.com/huroqu90
| | - Amanda Ghanie
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Rajika Jindani
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mohamed K Kamel
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, NY
| | - Roger Zhu
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Neel P Chudgar
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Brendon M Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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National Thoracic Surgery Standards Implementation: Barriers, Enablers, and Opportunities. ACTA ACUST UNITED AC 2021; 28:405-416. [PMID: 33450804 PMCID: PMC7903269 DOI: 10.3390/curroncol28010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022]
Abstract
Background: Diagnosis and surgical treatment decision making for thoracic cancers is complex. Moreover, there is demonstrated variability in how each province in Canada delivers cancer care, resulting in disparities in patient outcomes. Recently, the Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based standards for the care of thoracic surgery cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants to their implementation nationally. Methods: This study was undertaken in two parts: (1) a national survey of thoracic surgeons to assess the perceived extent of implementation of these standards in their institution and province; and (2) formation of a focus group with a representative sample of thoracic surgeons across Canada in a qualitative study to understand the determinants of successful standards implementation. Results: 37 surgeons (33% response rate) participated in the survey; 78% were from academic hospitals. The top categories of standards that were under-implemented included (a) quality assurance processes, data collection and clinician audit and feedback, and (b) ongoing regional planning and workload assessments for thoracic surgeons, and (c) pathology turnaround time target of two weeks and the use of a standardized synoptic pathology report format. Enablers, barriers, and opportunities for standards implementation contextualized the discussion within the focus group. Conclusion: Study results demonstrated variation in the implementation of surgery standards across Canada and identified the determinants to the delivery of high quality surgical care. Future work will need to include the promotion and development of quality improvement strategies and effective resource allocation that is aligned with the implementation of thoracic cancer surgery standards in order to improve patient outcomes.
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Robold T, Ried M, Neu R, Hofmann HS. [Minimum volumes in surgical treatment of lung cancer : A survey of thoracic surgeons in Germany on the introduction of a minimum volume regulation for surgical treatment of lung cancer]. Chirurg 2020; 91:1053-1061. [PMID: 32382805 PMCID: PMC7716896 DOI: 10.1007/s00104-020-01185-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Federal Joint Committee (G‑BA) is currently discussing the introduction of new minimum volume regulations (MVR) in Germany. The present study examined the current opinions of active thoracic surgeons regarding minimum volumes (MV) for the surgical treatment of lung cancer. METHODS The participating centers for the online survey were identified on the basis of the thoracic surgery departments in the 2017 hospital directory (Federal Statistical Office), lung cancer centers (German Cancer Society), certified centers of excellence for thoracic surgery (German Society for Thoracic Surgery), hospitals with a focus on lung surgery and German university hospitals. They were asked about the potential effects of MVR on the quality of results and quality of care, economic aspects and the structure of care. Furthermore, a recommendation for MV was requested and possible provisions for exemption were evaluated. RESULTS A total of 145 hospitals (response rate 85%) with 454 thoracic surgeons (response rate 54%) were surveyed. The results showed a high degree of approval for MV to improve the quality of results and 78.4% of the surgeons surveyed expected it to result in centralization of surgical care, although this would not lead to a deterioration in care according to 70.1% of the participants. Approximately 46.1% of the participants expected care to become more economical and 83.3% supported the introduction of an MVR, with the average recommended MV being 67 anatomical lung resections per center per year. CONCLUSION An MVR for the surgical treatment of lung cancer met with a high degree of approval among active thoracic surgeons. The MV that was called for (n = 67) was slightly below the prerequisite for primary surgical cases at a certified lung cancer center.
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Affiliation(s)
- Tobias Robold
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Deutschland.
| | - Michael Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Deutschland
| | - Reiner Neu
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Deutschland
| | - Hans-Stefan Hofmann
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Deutschland
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Kommalapati A, Tella SH, Appiah AK, Smith L, Ganti AK. Association Between Treatment Facility Volume, Therapy Types, and Overall Survival in Patients With Stage IIIA Non-Small Cell Lung Cancer. J Natl Compr Canc Netw 2020; 17:229-236. [PMID: 30865920 DOI: 10.6004/jnccn.2018.7086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is significant heterogeneity in the treatment of stage IIIA non-small cell lung cancer (NSCLC). This study evaluated the therapeutic and survival disparities in patients with stage IIIA NSCLC based on the facility volume using the National Cancer Database. METHODS Patients with stage IIIA NSCLC diagnosed from 2004 through 2015 were included. Facilities were classified by tertiles based on mean patients treated per year, with low-volume facilities treating ≤8 patients, intermediate-volume treating 9 to 14 patients, and high-volume treating ≥15 patients. Cox multivariate analysis was used to determine the volume-outcome relationship. RESULTS Analysis included 83,673 patients treated at 1,319 facilities. Compared with patients treated at low-volume facilities, those treated at high-volume centers were more likely to be treated with surgical (25% vs 18%) and trimodality (12% vs 9%) therapies. In multivariate analysis, facility volume was independently associated with all-cause mortality (P<.0001). Median overall survival by facility volume was 15, 16, and 19 months for low-, intermediate-, and high-volume facilities, respectively (P<.001). Compared with patients treated at high-volume facilities, those treated at intermediate- and low-volume facilities had a significantly higher risk of death (hazard ratio, 1.09 [95% CI, 1.07-1.11] and 1.11 [95% CI, 1.09-1.13], respectively). CONCLUSIONS Patients treated for stage IIIA NSCLC at high-volume facilities were more likely to receive surgical and trimodality therapies and had a significant improvement in survival.
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Affiliation(s)
- Anuhya Kommalapati
- Department of Internal Medicine, University of South Carolina School of Medicine, and.,Palmetto Health USC Medical Group, Columbia, South Carolina; and
| | - Sri Harsha Tella
- Department of Internal Medicine, University of South Carolina School of Medicine, and.,Palmetto Health USC Medical Group, Columbia, South Carolina; and
| | - Adams Kusi Appiah
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, and
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, and
| | - Apar Kishor Ganti
- Department of Hematology and Oncology, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
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Clark JM, Cooke DT, Chin DL, Utter GH, Brown LM, Nuño M. Does one size fit all? An evaluation of the 2018 Leapfrog Group minimal hospital and surgeon volume thresholds for lung surgery. J Thorac Cardiovasc Surg 2019; 159:2071-2079.e2. [PMID: 31740117 DOI: 10.1016/j.jtcvs.2019.09.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. METHODS We assessed lung cancer patients undergoing lobectomy or pneumonectomy in the New York and Florida State Inpatient Databases for 2007 to 2013. Multivariate logit models evaluated in-hospital mortality, complications, and prolonged length of stay. Median surgeon and hospital volumes were compared between "younger-healthier" (age 18-60 years, Elixhauser Comorbidity Index <1) and "older-sicker" patients (age >77 years, Elixhauser Comorbidity Index >3). RESULTS The 27,841 patients included 13,277 men (48%). The median patient age was 69 years (interquartile range, 61-77), and mortality was 2.1%. Patients treated by both low-volume surgeons (<15 annual cases) and at low-volume hospitals (<40) had the greatest risk of mortality (2.5%), except for the cohort of younger-healthier patients (mortality <2%). Mortality for older-sicker patients was highest for high-volume surgeons (12%), although higher hospital volume was protective. Increasing hospital volume was associated with decreased mortality (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.995-0.998; P = .0103), complications (OR, 0.998; 95% CI, 0.997-0.999; P < .001), and prolonged length of stay (OR, 0.998; 95% CI, 0.997-1.00; P = .01); similarly, higher surgeon volume was associated with decreased mortality (OR, 0.997; 95% CI, 0.99-1.00; P = .03), complications (OR, 0.997; 95% CI, 0.994-1.00; P = .02), and prolonged length of stay (OR, 0.991; 95% CI, 0.986-0.995; P < .01). CONCLUSIONS Hospital volume has a greater effect on morbidity and mortality than surgeon volume especially for older-sicker patients, suggesting that Leapfrog Group volume guidelines should emphasize hospital volume over surgeon volume and may be less relevant for younger-healthier patients.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis, Calif
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis, Calif; Department of Surgery, Outcomes Research Group, University of California, Davis, Calif
| | - David L Chin
- Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Mass
| | - Garth H Utter
- Department of Surgery, Outcomes Research Group, University of California, Davis, Calif; Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, University of California, Davis, Calif
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis, Calif; Department of Surgery, Outcomes Research Group, University of California, Davis, Calif
| | - Miriam Nuño
- Department of Surgery, Outcomes Research Group, University of California, Davis, Calif; Center for Healthcare Policy and Research, University of California, Davis, Calif; Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Calif.
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刘 宝. [Diagnosis and Treatment of Pulmonary Ground-glass Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:449-456. [PMID: 31315784 PMCID: PMC6712268 DOI: 10.3779/j.issn.1009-3419.2019.07.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 12/19/2022]
Abstract
Recent widespread use of high resolution computed tomography (HRCT) for the screening of lung cancer have led to an increase in the detection rate of very faint and smaller lesions known as ground-glass nodule (GGN). However, it had been proved that GGN was well associated with lung cancer in previous studies. Therefore, the classification, imaging characteristics, pathological type, follow-up, suggested managements and other clinical concerns of GGN were reviewed in this paper.
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Affiliation(s)
- 宝东 刘
- />100053 北京,首都医科大学宣武医院胸外科Department of Toracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Yano T, Shimokawa M, Kawashima O, Takenoyama M, Yamashita Y, Fukami T, Ueno T, Yatsuyanagi E, Fukuyama S. The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer. Gen Thorac Cardiovasc Surg 2018; 66:344-350. [DOI: 10.1007/s11748-018-0919-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/31/2018] [Indexed: 11/29/2022]
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Gunn J, Valo J, Sipilä J, Rautava P, Sihvo E, Kytö V. Trends and results of lung cancer surgery in Finland between 2004 and 2014†. Eur J Cardiothorac Surg 2018; 54:127-133. [DOI: 10.1093/ejcts/ezx486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jarmo Gunn
- Heart Center, Turku University Hospital, Turku, Finland
| | - Johanna Valo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jussi Sipilä
- Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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Yano T, Kawashima O, Takeo S, Adachi H, Tagawa T, Fukuyama S, Shimokawa M. A Prospective Observational Study of Pulmonary Resection for Non-small Cell Lung Cancer in Patients Older Than 75 Years. Semin Thorac Cardiovasc Surg 2017; 29:540-547. [PMID: 29698655 DOI: 10.1053/j.semtcvs.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 11/11/2022]
Abstract
The operative morbidity rate in elderly patients with lung cancer is high in comparison to nonelderly patients, probably because of the increase in comorbidities that occurs with aging. However, previous reports were retrospective and were performed at single institutions; thus, the preoperative comorbidities and operative morbidity could not be fully assessed. We conducted a multi-institutional prospective observational study of elderly patients (>75 years of age) with a completely resected non-small cell lung cancer. From March 2014 to April 2015, 264 patients from 22 hospitals affiliated with the National Hospital Organization in Japan were prospectively registered in the present study. The primary end point was operative morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0). The secondary end points were operative mortality and the risk factors for operative morbidity. Preoperative comorbidities were assessed according to the Adult Comorbidity Evaluation-27 index. The mean age at the time of surgery was 79.3 years (range 75-90 years). Forty-one percent of the patients were >80 years of age. Twenty-six percent underwent sublobar resection. The incidence of morbidities of any grade was 43.2% (90% confidence interval: 38.2%-48.2%). Respiratory system-related morbidity (19.3%), followed by cardiovascular system-related morbidity (10.2%), was the most common morbidity. The in-hospital mortality rate was 1.1% (3 of 264 patients). A multivariate analysis of the risk factors for operative morbidity showed that both Adult Comorbidity Evaluation-27 grade and the blood loss volume were significant factors. The results of the present prospective multi-institutional study should be used as a reference in the surgical treatment of elderly patients with lung cancer.
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Affiliation(s)
- Tokujiro Yano
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan.
| | - Osamu Kawashima
- Department of Chest Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Tsutomu Tagawa
- Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Seiichi Fukuyama
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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Migliore M, Criscione A, Calvo D, Borrata F, Nardini M, Di Masi P, Gangemi M, Scalieri F. Safety of video-assisted thoracic surgery lobectomy for non-small-cell lung cancer in a low-volume unit. Future Oncol 2016; 12:47-50. [DOI: 10.2217/fon-2016-0367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Several studies have demonstrated that for complex surgical procedures, surgeons who treat more patients have better outcomes than their lower-volume counterparts. The aim of this paper is to review the experience with video-assisted thoracic surgery (VATS) lobectomies in our small thoracic unit (group A), to understand whether our short-term results were different to the outcomes obtained by the same surgeon previously working in a high-volume unit (group B). 37 patients underwent VATS lobectomy. Hospital stay was on average 4.5 days (group A) versus 4.1 days (group B). Operative time and the number of ‘frozen sections’ were higher in group A. Hospital mortality was 0. VATS lobectomies are a safe approach in a low-volume unit formed by a single surgeon with a previous high-volume experience.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Marco Nardini
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Paola Di Masi
- Medical student, Faculty of Medicine University of Catania, Catania, Italy
| | - Mariapia Gangemi
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Francesco Scalieri
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
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Baciweicz FA. Surgeon volume and procedure selection. J Thorac Cardiovasc Surg 2016; 151:1218-9. [PMID: 26995629 DOI: 10.1016/j.jtcvs.2015.10.110] [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: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Frank A Baciweicz
- Professor of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Wayne State University School of Medicine, Detroit, Mich
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12
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How do surgeons decide on the extent of resection for patients with lung cancer? J Thorac Cardiovasc Surg 2015; 150:458-9. [PMID: 26077000 DOI: 10.1016/j.jtcvs.2015.05.048] [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: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 11/22/2022]
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