The role of the surgical volume for clinical outcomes in VATS lobectomy for lung cancer: a national large database multicenter analysis

Luca Bertolaccini, Elena Prisciandaro, Clarissa Uslenghi, Matteo Chiari, Andrea Cara, Antonio Mazzella, Monica Casiraghi, Lorenzo Spaggiari, Marco Alloisio, Dario Amore, Luca Ampollini, Claudio Andreetti, Desideria Argnani, Guido Baietto, Alessandro Bandiera, Cristiano Benato, Mauro Roberto Benvenuti, Alessandro Bertani, Luca Bertolaccini, Luigi BortolottiEdoardo Bottoni, Cristiano Breda, Pierpaolo Camplese, Paolo Carbognani, Giuseppe Cardillo, Caterina Casadio, Giorgio Cavallesco, Roberto Cherchi, Roberto Crisci, Carlo Curcio, Andrea Dell’Amore, Vittorio Della Beffa, Giampiero Dolci, Andrea Droghetti, Paolo A Ferrari, Diego Fontana, Gaetano Gargiulo, Roberto Gasparri, Diego Gavezzoli, Marco Ghisalberti, Michele Giovanardi, Alessandro Gonfiotti, Francesco Guerrera, Andrea Imperatori, Maurizio Infante, Luciano Iurilli, Paolo Lausi, Fabio Lo Giudice, Francesco Londero, Camillo Lopez, Luca Luzzi, Maurizio Mancuso, Pio Maniscalco, Stefano Margaritora, Elisa Meacci, Giulio Melloni, Angelo Morelli, Felice Mucilli, Pamela Natali, Giampiero Negri, Samuele Nicotra, Mario Nosotti, Gianluca Pariscenti, Reinhold Perkmann, Fausto Pernazza, Emanuele Pirondini, Camilla Poggi, Francesco Puma, Majed Refai, Alessandro Rinaldo, Giovanna Rizzardi, Lorenzo Rosso, Nicola Rotolo, Emanuele Russo, Armando Sabbatini, Marco Scarci, Lorenzo Spaggiari, Alessandro Di Stefani, Piergiorgio Solli, Corrado Surrente, Alberto Terzi, Massimo Torre, Dami-ano Vinci, Andrea Viti, Luca Voltolini, Gino Zaccagna &, Francesco Zaraca

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Improving the quality of lung cancer care at a cost that can be sustained is a hotly debated issue. High-risk, low-volume procedures (such as lung resections) are believed to improve significantly when centralised in high-volume centres. However, limited evidence exists to support volume requirements in lung cancer surgery. On the other hand, there was no evidence that the number of lung resections affected either the short-term perioperative results or the long-term cost. Using data from an extensive nationwide registry, this study investigated the correlations between surgical volumes and selected perioperative outcomes. A retrospective analysis of a prospectively filled national registry that follows stringent quality assurance and security procedures was conducted to ensure data accuracy and security. Patients who underwent VATS lobectomy from 2014 to 2019 at the participating centres were included. Selected perioperative outcomes were reported. Total direct hospital cost is measured at discharge for hospitalisations with a primary diagnosis of lung cancer, hospital stay costs, and postoperative length of hospital stay after lobectomy. After the propensity score matched, centres were divided into three groups according to the surgical volume of the unit where VATS lobectomies were performed (high-volume centre: > 500 lobectomies; medium-volume centre: 200–500 lobectomies; low-volume centre: < 200 lobectomies). 11,347 patients were included and matched (low-volume center = 2890; medium-volume center = 3147; high-volume center = 2907). The mean operative time density plot (Fig. 1A) showed no statistically significant difference (p = 0.67). In contrast, the density plot of the harvested lymph nodes (Fig. 1B) showed significantly higher values in the high-volume centres (p = 0.045), albeit without being clinically significant. The adjusted rates of any and significant complications were higher in the low-volume centre (p = 0.034) without significantly affecting the length of hospital stay (p = 0.57). VATS lobectomies for lung cancer in higher-volume centres seem associated with a statistically significantly higher number of harvested lymph nodes and lower perioperative complications, yet without any significant impact in terms of costs and resource consumption. These findings may advise the investigation of the learning curve effect in a complete economic evaluation of VATS lobectomy in lung cancer. (Figure presented.)
Lingua originaleEnglish
pagine (da-a)1475-1482
Numero di pagine8
RivistaUpdates in Surgery
Volume76
DOI
Stato di pubblicazionePubblicato - 2024

Keywords

  • Lobectomy
  • VATS
  • Surgical volume
  • Lung cancer

Fingerprint

Entra nei temi di ricerca di 'The role of the surgical volume for clinical outcomes in VATS lobectomy for lung cancer: a national large database multicenter analysis'. Insieme formano una fingerprint unica.

Cita questo