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Akinbobola O, Ray MA, Fehnel C, Saulsberry A, Dortch K, Smeltzer M, Faris NR, Osarogiagbon RU. Institution-Level Evolution of Lung Cancer Resection Quality With Implementation of a Lymph Node Specimen Collection Kit. J Thorac Oncol 2023; 18:858-868. [PMID: 36931504 PMCID: PMC10505555 DOI: 10.1016/j.jtho.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/25/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION 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 preimplementation and postimplementation phases of kit deployment and, within implementing institutions, resections without versus with the kit. Benchmarks included rates of nonexamination of lymph nodes, nonexamination of mediastinal lymph nodes, and attainment of American College of Surgeons Operative Standard 5.8. We report institution-level adjusted ORs (aORs) for attaining quality benchmarks. RESULTS From 2009 to 2020, three preimplementing hospitals had 953 resections; 11 implementing hospitals had 4013 resections, 58% without and 42% with the kit. Quality was better in implementing institutions and with kit cases. Compared with preimplementing institutions, the aOR for nonexamination of lymph nodes was 0.62 (0.49-0.8, p = 0.002), nonexamination of mediastinal lymph nodes was 0.56 (0.47-0.68, p < 0.0001), and attainment of Operative Standard 5.8 was 7.3 (5.6-9.4, p < 0.0001); aORs 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 preimplementing 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 nonkit cases had a low level of quality, approximating that of preimplementing institutions. Within implementing institutions, 5-year overall survival was 61% versus 51% after surgery with versus without the kit (p < 0.001). CONCLUSIONS Surgery with a lymph node specimen collection kit improved institution-level quality of curative-intent lung cancer resection.
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Affiliation(s)
- Olawale Akinbobola
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Meredith A Ray
- School of Public Health, University of Memphis, Memphis, Tennessee
| | - Carrie Fehnel
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Andrea Saulsberry
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Kourtney Dortch
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Matthew Smeltzer
- School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nicholas R Faris
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Raymond U Osarogiagbon
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee; Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
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Ng KS, West NP, Scott N, Holzgang M, Quirke P, Jayne DG. What factors determine specimen quality in colon cancer surgery? A cohort study. Int J Colorectal Dis 2020; 35:869-880. [PMID: 32112199 DOI: 10.1007/s00384-020-03541-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Tenets of 'good quality' colon cancer surgery include mesocolic plane dissection to preserve an intact mesocolic fascia/peritoneum, and excision of sufficient mesocolon for adequate lymphadenectomy. However, it remains controversial what clinicopathological factors determine 'good quality' surgery, and whether quality of surgery influences morbidity/mortality. This study documents the quality of colon cancer surgery at a quaternary referral centre and identifies factors that influence quality of surgery and post-operative outcomes. METHODS Consecutive patients who underwent resection for colon adenocarcinoma at St. James's University Hospital, Leeds, UK (2015-2017), were included. Primary outcome measures included (i) plane of mesocolic dissection, prospectively assessed; and (ii) tissue morphometry (area of mesentery and vascular pedicle length). Other histopathological data were extracted from a prospective database. Clinical data were obtained from the National Bowel Cancer Audit and individual records. RESULTS Four hundred five patients were included (mean 69.6 years). The majority (67.4%) of specimens were mesocolic plane dissections. Median area of mesentery excised was 12,085.4 mm2. Median vascular pedicle length was 89.3 mm. Post-operative complication was recorded in one-third of patients. Mesocolic plane excision was associated with open surgery (OR 1.80, 95% CI 1.05-3.09), especially in emergency colectomy. Open resections also had a greater mesentery excised (P = 0.002), but incurred more post-operative complication (OR 2.11, 95% CI 1.12-3.99). Post-operative complication was not associated with plane of excision or tissue morphometry. CONCLUSION Majority of resections were 'optimal' mesocolic plane dissections. Open resections yielded better quality specimens, but incurred more morbidity. There is room for improvement in the quality of laparoscopic colon cancer surgery, particularly those performed as emergency.
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Affiliation(s)
- Kheng-Seong Ng
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK. .,RPA Institute of Academic Surgery, University of Sydney, 145-147 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Nicholas P West
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Nigel Scott
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Melanie Holzgang
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK
| | - Phil Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - David G Jayne
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK.,Academic Surgery, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Sandrucci S, Ponzetti A, Gianotti C, Mussa B, Lista P, Grignani G, Mistrangelo M, Bertetto O, Di Cuonzo D, Ciccone G. Different quality of treatment in retroperitoneal sarcomas (RPS) according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy. Clin Sarcoma Res 2018; 8:3. [PMID: 29507712 PMCID: PMC5830336 DOI: 10.1186/s13569-018-0091-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Retroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers. However, it is not clearly demonstrated if clinical outcome is more influenced by Center Case Volume (CCV) or by Surgeon Case Volume (SCV). The aim of this study is to retrospectively explore the relationship between CCV and SCV and the quality of surgery in a wide region of Northern Italy. Methods We retrospectively collected data about patients M0 surgically treated for RPSs in 22 different hospitals from 2006 to 2011, dividing them in two hospital groups according to sarcoma clinical activity volume (HCV, high case volume or LCV, low case volume hospitals). The HCV group (> 100 sarcomas observed per year) included a Comprehensive Cancer Center (HVCCC) with a high sarcoma SCV (> 20 cases/year), and a Tertiary Academic Hospital (HVTCA) with multiple surgeon teams and a low sarcoma SCV (≤ 5 cases/year for each involved surgeon). All other hospitals were included in the LCV group (< 100 sarcomas observed per year). Results Data regarding 138 patients were collected. Patients coming from LCV hospitals (66) were excluded from the analysis as prognostic data were frequently not available. Among the 72 remaining cases of HCV hospitals 60% of cases had R0/R1 margins, with a more favorable distribution of R0/R1 versus R2 in HVCCC compared to HVTCA. Conclusions In HCV hospitals, sarcoma SCV may significantly influence RPS treatment quality. In low-volume centers surgical reports can often miss important prognostic issues and surgical quality is generally poor.
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Affiliation(s)
- Sergio Sandrucci
- 1Visceral Sarcoma Unit, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy
| | - Agostino Ponzetti
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Claudio Gianotti
- 1Visceral Sarcoma Unit, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy
| | - Baudolino Mussa
- 3Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Patrizia Lista
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Giovanni Grignani
- 4Department of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | | | - Daniela Di Cuonzo
- Cancer Epidemiology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Giovannino Ciccone
- Cancer Epidemiology Unit, Città della Salute e della Scienza, Turin, Italy
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Falcone F, Scambia G, Benedetti Panici P, Signorelli M, Cormio G, Giorda G, Bogliolo S, Marinaccio M, Ghezzi F, Rabaiotti E, Breda E, Casella G, Fanfani F, Di Donato V, Leone Roberti Maggiore U, Greggi S. Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study. Gynecol Oncol 2017; 147:66-72. [PMID: 28716306 DOI: 10.1016/j.ygyno.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. METHODS A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. RESULTS A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. CONCLUSIONS This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.
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Affiliation(s)
- F Falcone
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy; Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - P Benedetti Panici
- Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| | - M Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Cormio
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy; Gynecologic Oncology Unit, National Cancer Institute, Bari, Italy
| | - G Giorda
- Department of Gynecological Oncology, CRO National Cancer Institute, Aviano, Italy
| | - S Bogliolo
- Department of Obstetrics and Gynaecology, IRCCS Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - M Marinaccio
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - F Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - E Rabaiotti
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - E Breda
- Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - G Casella
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - F Fanfani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - V Di Donato
- Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
| | | | - S Greggi
- Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy.
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