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Quality of surgical resection for nonsmall cell lung cancer in a US metropolitan area
Article first published online: 24 AUG 2010
Copyright © 2010 American Cancer Society
Volume 117, Issue 1, pages 134–142, 1 January 2011
How to Cite
Allen, J. W., Farooq, A., O'Brien, T. F. and Osarogiagbon, R. U. (2011), Quality of surgical resection for nonsmall cell lung cancer in a US metropolitan area. Cancer, 117: 134–142. doi: 10.1002/cncr.25334
- Issue published online: 16 DEC 2010
- Article first published online: 24 AUG 2010
- Manuscript Accepted: 10 FEB 2010
- Manuscript Revised: 9 FEB 2010
- Manuscript Received: 14 DEC 2009
- quality of care;
- nonsmall cell lung cancer;
- lymph node sampling;
Curative treatment of early stage nonsmall cell lung cancer (NSCLC) requires good quality surgical resection (GQR). The degree of compliance with national recommendations for GQR is poorly defined. We sought to quantitatively define the degree of compliance in a consecutive series of NSCLC resections.
Medical records of patients who underwent curative-intent resection for NSCLC in the Memphis, TN metropolitan area from January 1, 2004 to December 31, 2007 were retrospectively reviewed (N = 746 patients). GQR criteria were obtained from the National Comprehensive Cancer Network (NCCN), the RADIANT adjuvant study of erlotinib, and the American College of Surgeons Oncology Group (ACOSOG) Z0030 study. Factors associated with or without achievement of GQR were evaluated. Categorical variables were compared using chi-square or Fisher exact test, and survival curves by the log-rank test.
Twenty-three and one-half percent of patients met GQR criteria as established by RADIANT, 8.2% by NCCN, and 0.9% by ACOSOG. The most common limiting factor in achieving GQR was inadequate lymph node sampling. The only patient factor associated with GQR was race (African-Americans were more likely than Caucasians to have GQR per RADIANT and NCCN criteria [P = .022 and P = .0489, respectively]). There was no significant survival difference between GQR and non-GQR patients.
The vast majority of curative-intent resections did not achieve GQR standards. The greatest deficit is in surgical sampling of mediastinal (Level 2) lymph nodes, but evaluation of Level 1 lymph nodes is also suboptimal. Interventions are needed to improve current surgical practices and achieve minimum standards for accurate staging, prognostication, and eligibility for clinical trials. Cancer 2011. © 2010 American Cancer Society.