SCI

29 March 2023

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

(JTO, IF: 20.121)

Akinbobola Olawale,Ray Meredith A,Fehnel Carrie et al. Institution-Level Evolution of Lung Cancer Resection Quality with Implementation of a Lymph Node Specimen Collection Kit.[J] .J Thorac Oncol, 2023, undefined: undefined.

BACKGROUND 背景

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

肺癌手术与淋巴结采集盒改善患者层面的预后，但机构层面的影响尚未得到证实。

METHODS 方法

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.

采用机构阶梯式楔形实施研究设计，我们比较了各机构在采集盒部署前和部署后的肺癌切除质量，以及在实施机构内，不使用采集盒和使用采集盒的切除质量。基准包括不检查淋巴结(pNX)、不检查纵隔淋巴结和达到美国外科医生学会操作标准5.8。我们报告达到质量基准的机构层面调整优势比(aOR)。

RESULTS 结果 

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).

2009-2020年，3家实施前医院共切除953例；11家使用该采集盒的医院共有4013例手术，58%未使用该采集盒，42%使用该采集盒。使用采集盒的机构和病例的手术质量较好。与实施前机构相比，pNX的aOR为0.62 (0.49-0.8, P=0.002)，不检查纵隔淋巴结为0.56 (0.47-0.68, P<0.0001)，达到手术标准5.8为0.62 (0.49-0.8, P=0.002);使用采集盒的病例的aOR分别为0.01(0.001-0.06)、0.08(0.06-0.11)和11.6 (9.9-13.7)，P均<0.0001。在实施前的机构中，手术质量持续较差，但在实施机构中，随着采集盒的使用，手术质量逐步提高。在实施机构中，使用采集盒的切除具有统一的高质量水平，而非采集盒病例的质量水平较低，接近于实施前的机构。在实施该采集盒的机构中，用采集盒对比不用采集盒术后5年总生存率分别为61%和51% (p<0.001)。

CONCLUSION 结论 

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

采用淋巴结标本采集盒的手术可提高机构层面肺癌切除术的质量。

来源 | 健康界

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