دورية أكاديمية
Effect of thoracic surgery regionalization on long-term survival after lung cancer resection.
| العنوان: | Effect of thoracic surgery regionalization on long-term survival after lung cancer resection. |
|---|---|
| المؤلفون: | Ely S; Department of Surgery, UCSF East Bay, Highland Hospital, Oakland, Calif; Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, Calif. Electronic address: sora.ely@ucsf.edu., Jiang SF; Division of Research, Kaiser Permanente Northern California, Oakland, Calif., Dominguez DA; Department of Surgery, UCSF East Bay, Highland Hospital, Oakland, Calif; Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, Calif., Patel AR; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, Calif., Ashiku SK; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, Calif., Velotta JB; Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, Calif. |
| المصدر: | The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2022 Mar; Vol. 163 (3), pp. 769-777. Date of Electronic Publication: 2021 Mar 20. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't; Video-Audio Media |
| اللغة: | English |
| بيانات الدورية: | Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: St. Louis, MO : Mosby Original Publication: St. Louis. |
| مواضيع طبية MeSH: | Centralized Hospital Services* , Delivery of Health Care, Integrated* , Pneumonectomy*/adverse effects , Pneumonectomy*/mortality , Regional Health Planning*, Carcinoma, Non-Small-Cell Lung/*surgery , Lung Neoplasms/*surgery, Aged ; Carcinoma, Non-Small-Cell Lung/mortality ; Carcinoma, Non-Small-Cell Lung/pathology ; Female ; Humans ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome |
| مستخلص: | Objective: Existing evidence demonstrates some benefit of regionalization on early postoperative outcomes following lung cancer resection, but data regarding the persistence of this effect in long-term mortality are lacking. We investigated whether previously reported improvements in short-term outcomes translated to long-term survival benefit. Methods: We retrospectively reviewed patients undergoing major pulmonary resection (lobectomy, bilobectomy, or pneumonectomy) for cancer within our integrated health care system before (2011-2013; n = 782) and after (2015-2017; n = 845) thoracic surgery regionalization. Overall survival was compared by Kaplan-Meier analysis, and 1- and 3-year mortality was compared by the by χ 2 or Fisher exact test. Multivariable Cox regression models evaluated the effect of regionalization on mortality adjusted for relevant factors. Results: Kaplan-Meier curves showed that overall survival was better among patients undergoing surgery postregionalization (log-rank test, P < .0001). Both 1- and 3-year mortality were decreased after regionalization: to 5.7% from 11.1% (P < .0001) for 1 year and to 17.0% from 25.5% (P = .0002) for 3 years. The multivariable adjusted Cox regression analysis revealed that only regionalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.42-0.76), age (HR, 1.03; 95% CI, 1.02-1.04), cancer stage (HR, 1.72, 1.83, and 2.56 for stages II, III, and IV, respectively), and Charlson comorbidity index (HR, 1.80 for 1-2; 2.05 for ≥3) were independent predictors of mortality. Conclusions: We found that overall mortality as well as 1- and 3-year mortality for lung cancer resection were lower after thoracic surgery regionalization. The association between regionalization and reduced mortality was significant even after adjusting for other related factors in a multivariable Cox analysis. Notably, surgeon volume, facility volume, surgeon specialty, neoadjuvant treatment, and video-assisted thoracoscopic surgery approach did not significantly affect mortality in the adjusted model. (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.) |
| التعليقات: | Comment in: J Thorac Cardiovasc Surg. 2022 Mar;163(3):778. (PMID: 33962755) |
| فهرسة مساهمة: | Keywords: lung cancer; lung resection; minimally invasive procedures/robotics; outcomes; perioperative management; regionalization; survival |
| تواريخ الأحداث: | Date Created: 20210503 Date Completed: 20220228 Latest Revision: 20220228 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.jtcvs.2021.03.050 |
| PMID: | 33934900 |
| قاعدة البيانات: | MEDLINE |
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