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Journal of Thoracic Oncology
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Original Article|Articles in Press

Institution-Level Evolution of Lung Cancer Resection Quality with Implementation of a Lymph Node Specimen Collection Kit.

Published:March 15, 2023DOI:https://doi.org/10.1016/j.jtho.2023.03.002
Institution-Level Evolution of Lung Cancer Resection Quality with Implementation of a Lymph Node Specimen Collection Kit.
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      Abstract

      Background

      Lung cancer surgery with a lymph node kit improves patient-level outcomes, but institution-level impact is unproven.

      Methods

      Using an institutional stepped-wedge implementation study design, we compared lung cancer resection quality between institutions in pre- and post-implementation phases of kit deployment and, within implementing institutions, resections without versus with the kit. Benchmarks included rates of non-examination of lymph nodes (pNX), non-examination of mediastinal lymph nodes and attainment of American College of Surgeons Operative Standard 5.8. We report institution-level adjusted odds ratios (aOR) for attaining quality benchmarks.

      Results

      From 2009-2020, three pre-implementing hospitals had 953 resections; 11 implementing hospitals had 4,013 resections, 58% without and 42% with the kit. Quality was better in implementing institutions, and with kit cases. Compared to pre-implementing institutions, the aOR for pNX was 0.62 (0.49-0.8, P=0.002), non-examination of mediastinal lymph nodes 0.56 (0.47-0.68, P<0.0001), attainment of Operative Standard 5.8 7.3 (5.6-9.4, P<0.0001); aOR for kit cases were 0.01 (0.001-0.06), 0.08 (0.06-0.11) and 11.6 (9.9-13.7), respectively, P<0.0001 for all.
      Surgical quality was persistently poor in pre-implementing institutions, but sequentially improved in implementing institutions in parallel with kit adoption. In implementing institutions, resections with the kit had a uniformly high level of quality, whereas non-kit cases had a low level of quality, approximating that of pre-implementing institutions. Within implementing institutions, 5-year overall survival was 61% versus 51% after surgery with versus without the kit (p<0.001).

      Conclusion

      Surgery with a lymph node specimen collection kit improved institution-level quality of curative-intent lung cancer resection.

      Key Words

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      Article info

      Publication history

      Accepted: March 6, 2023
      Received in revised form: January 25, 2023
      Received: August 22, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Funding: Supported by R01CA172253

      Conflict of Interest Statement: Patents for surgical specimen collection kit; stocks in Pfizer, Gilead Sciences, and Eli Lilly; paid research consultant for the American Cancer Society, the Association of Community Cancer Centers, Genentech/Roche, Biodesix, Lungevity Foundation, National Cancer Institute, Tryptych Healthcare Partners, and AstraZeneca; founder Oncobox Device, Inc. (Osarogiagbon). Paid research consultant for the Association of Community Cancer Centers (Smeltzer).

      CRediT Roles Statement:

      Olawale Akinbobola: Data curation, formal analysis, validation, writing - review and editing; Meredith A. Ray: Formal analysis, methodology, supervision, validation, writing - review and editing; Carrie Fehnel: Data curation, project administration, writing – review and editing; Andrea Saulsberry: Data curation, Kourtney Dortch: Data curation, writing—reviewing and editing writing—reviewing and editing; Matthew Smeltzer: Methodology, validation, writing - review and editing Nick Faris: Data curation, project administration, supervision, writing – review and editing; Raymond U. Osarogiagbon: Conceptualization, funding acquisition, investigation, visualization, resources, supervision, writing – original draft, review and editing.

      Identification

      DOI: https://doi.org/10.1016/j.jtho.2023.03.002

      Copyright

      © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

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