The Relationship Between Volume or Surgeon Specialty and Outcome in the Surgical Treatment of Lung Cancer: A Systematic Review and Meta-Analysis

Meyenfeldt, Erik M. von; Gooiker, G.A.; Gijn, W. van; Post, Piet N.; Velde, Cornelis J.H. van de; Tollenaar, Rob A.E.M.; Klomp, Houke M.; Wouters, Michel W. J. M.

doi:10.1097/jto.0b013e318257cc45

Cited by 120 publications

(83 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although some facilities may be able to purchase missing infrastructure components such as a PET scanner, it is unrealistic to assume that all facilities that care for patients eligible for screening will have a high enough volume of patients with lung cancer to warrant investment in bringing policy-recommended services such as radiation oncology or thoracic surgery to the facility. Even if they did, they may not be ideally poised to offer optimal care, because hospitals with a lower volume of patients with lung cancer may provide less guideline-concordant care than do high-volume hospitals, and outcomes of lung cancer resections are worse among lower-volume surgeons (27,28). Furthermore, it is not clear whether having resources such as PET scanners or radiation oncology services on site improves Figure 1.…”

Section: Discussionmentioning

confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

View full text Add to dashboard Cite

Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. Measurements and Main Results:The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policyrecommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

show abstract

Section: Discussionmentioning

confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

View full text Add to dashboard Cite

show abstract

“…General surgeons had significantly higher mortality risks than general thoracic (OR 0.78, 95% CI 0.70-0.88) or cardiothoracic surgeons (OR 0.82, 95% CI 0.69-0.96). A minimal annual volume of resections for better outcome could not be identified [18]. More data are necessary for performing evidence-based recommendations.…”

Section: Nonsmall Cell Lung Cancer Treatment Surgerymentioning

confidence: 99%

“…The effect of procedural volume and surgeon specialty on outcome of lung resections for cancer has been assessed in a systematic review of the literature with meta-analysis [18]. 19 studies published in English over the past 20 years were selected.…”

Section: Nonsmall Cell Lung Cancer Treatment Surgerymentioning

confidence: 99%

Updates in oncology

Sculier¹,

Meert²,

Berghmans³

2014

Eur Respir Rev

View full text Add to dashboard Cite

The objective of this review is to report the Clinical Year in Review proceedings in the field of thoracic oncology that were presented at the 2013 European Respiratory Society Annual Congress in Barcelona, Spain. Various topics were reviewed, including: epidemiology, screening, histology, and treatment of nonsmall cell lung cancer and small cell lung cancer. @ERSpublications Lung cancer increasing in females; screening based on risk selection; doublet platinum-based chemotherapy recommended http://ow.ly/sjbR6 EpidemiologyEuropean cancer mortality predictions for lung cancer in 2013 report a continuing reduction in males, but a continuing increase in females [1]. For the first time in females, mortality from lung and breast cancers should be equivalent. In 2013, age-standardised mortality rates per 100 000 are estimated to be 37.1 in males and 13.9 in females for lung cancer.A US epidemiological study [2] has confirmed the data of the UK doctors' cohort [3]. The authors obtained smoking and smoking-cessation histories from 113 752 females and 88 496 males who were interviewed between 1997 and 2004. These data were related to the causes of deaths that occurred by the end of 2006 (8236 deaths in females and 7479 in males). The rate of death from any cause among current smokers was approximately three times that among those who had never smoked. The hazard ratios for females and males were 3.0 (99% CI 2.7-3.3) and 2.8 (99% CI 2.4-3.1), respectively. Life expectancy was shortened by .10 years among the current smokers compared with those who had never smoked. Adults who had quit smoking 25-34, 35-44 or 45-54 years of age gained approximately 10, 9 and 6 years of life, respectively, compared with those who continued to smoke. This is in complete agreement with the UK observation.Temporal trends in mortality across three time-periods (1959-1965, 1982-1988 and 2000-2010) were compared in terms of absolute and relative risks according to sex and self-reported smoking status in two historical and five pooled contemporary US cohort studies [4]. For females who were current smokers compared with females who had never smoked, the relative risk of death from lung cancer was 2. 73, 12.65 and 25.66 in the 1960s, 1980s and contemporary cohorts, respectively; corresponding relative risk for male current smokers compared with males who had never smoked was 12.22, 23.81 and 24.97 over the same time-periods, respectively. As in Europe, the risk of death by lung cancer from cigarette smoking in the USA continues to increase among females and the increased risks are now nearly identical for males and females; however, this is not the case in Europe.By pooled analysis, the International Lung Cancer Consortium determined the associations between prior lung diseases and the occurrence of lung cancer [5]. The analysis included 17 studies with 24 607 cases and

show abstract

“…Patients operated on at high-volume hospitals have lower postoperative complication rates and lower 30-day mortality [189]. Outcomes seem to be better in large teaching hospitals [190,191] and the surgeon's specialisation, thoracic surgery versus general surgery or cardiothoracic surgery, also influences in-hospital mortality [192,193].…”

Section: Surgery In Patients With Impaired Pulmonary Functionmentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

View full text Add to dashboard Cite

Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

show abstract

The Relationship Between Volume or Surgeon Specialty and Outcome in the Surgical Treatment of Lung Cancer: A Systematic Review and Meta-Analysis

Cited by 120 publications

References 32 publications

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Updates in oncology

Surgery for nonsmall cell lung cancer

Contact Info

Product

Resources

About