Surgeon Specialty and Long-Term Survival After Pulmonary Resection for Lung Cancer

ArticleinThe Annals of thoracic surgery 87(4):995-1004; discussion 1005-6 · May 2009with11 Reads
DOI: 10.1016/j.athoracsur.2008.12.030 · Source: PubMed
Abstract
Long-term outcomes and processes of care in patients undergoing pulmonary resection for lung cancer may vary by surgeon type. Associations between surgeon specialty and processes of care and long-term survival have not been described. A cohort study (1992 through 2002, follow-up through 2005) was conducted using Surveillance, Epidemiology, and End-Results-Medicare data. The American Board of Thoracic Surgery Diplomates list was used to differentiate board-certified thoracic surgeons from general surgeons (GS). Board-certified thoracic surgeons were designated as cardiothoracic surgeons (CTS) if they performed cardiac procedures and as general thoracic surgeons (GTS) if they did not. Among 19,745 patients, 32% were cared for by GTS, 45% by CTS, and 24% by GS. Patient age, comorbidity index, and resection type did not vary by surgeon specialty (all p > 0.10). Compared with GS and CTS, GTS more frequently used positron emission tomography (36% versus 26% versus 26%, respectively; p = 0.005) and lymphadenectomy (33% versus 22% versus 11%, respectively; p < 0.001). After adjustment for patient, disease, and management characteristics, hospital teaching status, and surgeon and hospital volume, patients treated by GTS had an 11% lower hazard of death compared with those who underwent resection by GS (hazard ratio, 0.89; 99% confidence interval, 0.82 to 0.97). The risks of death did not vary significantly between CTS and GS (hazard ratio, 0.94; 99% confidence interval, 0.88 to 1.01) or GTS and CTS (hazard ratio, 0.94; 99% confidence interval, 0.87 to 1.03). Lung cancer patients treated by GTS had higher long-term survival rates than those treated by GS. General thoracic surgeons performed preoperative and intraoperative staging more often than GS or CTS.
    • "In this regard, a number of publications have shown consistent short-term and long-term benefits in managing oncological thoracic procedures by specialized thoracic surgeons vs nonspecialists [1] [2] [3] [4] [5]. "
    Dataset · Nov 2015 · The Annals of thoracic surgery
    • "Although surgeon characteristics are not available in our study, it is significant that a higher proportion of sublobar resections were performed in nonacademic centers than in academic centers. This is similar to the results from the Surveillance, Epidemiology, and End-Result database analysis, which found a significantly higher percentage of video-assisted thoracoscopic surgery (VATS) anatomic resections performed by general thoracic surgeons compared with other surgeon types [10]. Because lobectomy was independently associated with improved long-term survival, this could partially explain improved long-term survival of academic center patients. "
    [Show abstract] [Hide abstract] ABSTRACT: Improved survival of patients with early-stage non-small cell lung cancer (NSCLC) undergoing resection at high-volume centers has been reported. However, the effect of institution is unclear in stage IIIA NSCLC, where a variety of neoadjuvant and adjuvant therapies are used. Treatment and outcomes data of clinical stage IIIA NSCLC patients undergoing resection as part of multimodality therapy was obtained from the National Cancer Database. Multivariable regression models were fitted to evaluate variables influencing 30-day mortality and overall survival. From 1998 to 2010, 11,492 clinical stage IIIA patients underwent resection at community centers, and 7,743 patients received resection at academic centers. Academic center patients were more likely to be younger, female, non-Caucasian, have a lower Charlson-Deyo comorbidity score, and to receive neoadjuvant chemotherapy (49.6% vs 40.6%; all p < 0.001). Higher 30-day mortality was associated with increasing age, male gender, preoperative radiotherapy, and pneumonectomy. Patients undergoing operations at academic centers experienced lower 30-day mortality (3.3% vs 4.5%; odds ratio, 0.75; 95% confidence interval [CI], 0.60 to 0.93; p < 0.001). Decreased long-term survival was associated with increasing age, male gender, higher Charlson-Deyo comorbidity score, and larger tumors. Neoadjuvant chemotherapy (hazard ratio, 0.66; 95% CI, 0.62 to 0.70), surgical intervention at an academic center (hazard ratio, 0.92; 95% CI, 0.88 to 0.97), and lobectomy (hazard ratio, 0.72; 95% CI, 0.67 to 0.77) were associated with improved overall survival. Stage IIIA NSCLC patients undergoing resection at academic centers had lower 30-day mortality and increased overall survival compared with patients treated at community centers, possibly due to higher patient volume and an increased rate of neoadjuvant chemotherapy. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Jul 2015
    • "The unit should be headed by a surgeon preferably certified by the UEMS European Board of Thoracic Surgery (EBTS) or by an equivalent body recognized by the UEMS (national diploma of thoracic surgeon). This is in accordance with the most recent evidence from the literature showing a positive association between specialization and short-term or long-term outcomes in thoracic surgery2345789. This Head of unit should have educational and scientific responsibilities and should possess a minimum experience of 5 years of clinical practice as a qualified GTS surgeon [10]. "
    Full-text · Dataset · Aug 2014 · The Annals of thoracic surgery
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