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Open Access 01-01-2020 | Lung Cancer | Original Scientific Report

Pneumonectomy for Lung Cancer Treatment in The Netherlands: Between-Hospital Variation and Outcomes

Authors: Naomi Beck, Thomas J. van Brakel, Hans J. M. Smit, David van Klaveren, Michel W. J. M. Wouters, Wilhelmina H. Schreurs

Published in: World Journal of Surgery | Issue 1/2020

Abstract

Background

Pneumonectomy in lung cancer treatment is associated with considerable morbidity and mortality. Its use is reserved only for patients in whom a complete oncological resection by (sleeve) lobectomy is not possible. It is unclear whether a patients’ risk of receiving a pneumonectomy is equally distributed. This study examined between-hospital variation of pneumonectomy use for primary lung cancer in the Netherlands.

Methods

Data from the Dutch Lung Cancer Audit for Surgery from 2012 to 2016 were used to study the use of pneumonectomy for primary lung cancer in the Netherlands. Using multivariable logistic regression, factors associated with pneumonectomy use were identified and the expected number of pneumonectomies per hospital was determined. Subsequently, the observed/expected ratio (O/E ratio) per hospital was calculated to study between-hospital differences.

Results

Of the 8446 included patients, 659 (7.8%) underwent a pneumonectomy with a mean postoperative mortality of 7.1% (n = 47). Factors associated with receiving a pneumonectomy were age, gender, cardiac and pulmonary comorbidities, tumor side, size and histopathology. The pneumonectomy use in the Netherlands varied considerably between hospitals (IQR 5.5–10.1%). Three hospitals out of 51 performed significantly less pneumonectomies than expected (O/E ratio < 0.5) and three significantly more (O/E ratio > 1.7). In the latter group, severe complications were more frequent, taking other influencing factors into account (OR 1.51, 95% CI 1.05–2.19).

Conclusions

There is a considerable between-hospital variation in pneumonectomy use in lung cancer treatment. To further optimize surgical lung cancer care, we suggest center-specific feedback on pneumonectomy use and the development of a risk-adjusted pneumonectomy indicator.

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Kopec SE, Irwin RS, Umali-Torres CB, Balikian JP, Conlan AA (1998) The postpneumonectomy state. Chest 114:1158–1184. https://doi.org/10.1378/chest.114.4.1158 CrossRefPubMed

Falcoz PE, Conti M, Brouchet L, Chocron S, Puyraveau M, Mercier M et al (2007) The thoracic surgery scoring system (thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. J Thorac Cardiovasc Surg 133:325–332. https://doi.org/10.1016/j.jtcvs.2006.09.020 CrossRefPubMed

Brunelli A, Salati M, Rocco G, Varela G, Van Raemdonck D, Decaluwe H et al (2017) European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database. Eur J Cardio-Thorac Surg 51:1212. https://doi.org/10.1093/ejcts/ezx155 CrossRef

Fernandez FG, Kosinski AS, Burfeind W, Decamp MM, Seder C, Marshall B et al (2016) STS lung cancer resection risk model: higher quality data and superior outcomes. Ann Thorac Surg 102:370–377. https://doi.org/10.1016/j.athoracsur.2016.02.098.STS CrossRefPubMedPubMedCentral

Beck N, Hoeijmakers F, van der Willik EM, Heineman DJ, Braun J, Tollenaar RAEM et al (2018) National comparison of hospital performances in lung cancer surgery: the role of casemix adjustment. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2018.02.074 CrossRefPubMed

Jakobsen E, Palshof T, Østerlind K, Pilegaard H (2009) Data from a national lung cancer registry contributes to improve outcome and quality of surgery: Danish results. Eur J Cardio-Thorac Surg 35:348–352. https://doi.org/10.1016/j.ejcts.2008.09.026 CrossRef

Riaz SP, Linklater KM, Page R, Peake MD, Møller H, Lüchtenborg M (2012) Recent trends in resection rates among non-small cell lung cancer patients in England. Thorax 67:811–814. https://doi.org/10.1136/thoraxjnl-2012-201768 CrossRefPubMed

Powell HA, Tata LJ, Baldwin DR, Stanley RA, Khakwani A, Hubbard RB (2013) Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit. Thorax 68:826–834. https://doi.org/10.1136/thoraxjnl-2012-203123 CrossRefPubMed

Thomas PA, Berbis J, Baste JM, Le Pimpec-Barthes F, Tronc F, Falcoz PE et al (2015) Pneumonectomy for lung cancer: contemporary national early morbidity and mortality outcomes. J Thorac Cardiovasc Surg 149:73–82. https://doi.org/10.1016/j.jtcvs.2014.09.063 CrossRefPubMed

10.

Green A, Hauge J, Iachina M, Jakobsen E (2016) The mortality after surgery in primary lung cancer: results from the Danish Lung Cancer Registry. Eur J Cardio-Thoracic Surg 49:589–594. https://doi.org/10.1093/ejcts/ezv107 CrossRef

11.

Morgant MC, Pagès PB, Orsini B, Falcoz PE, Thomas PA, Le Pimpec Barthes F et al (2015) Time trends in surgery for lung cancer in France from 2005 to 2012: a nationwide study. Eur Respir J 46:1131–1139. https://doi.org/10.1183/13993003.00354-2015 CrossRefPubMed

12.

Seder CW, Raymond DP, Wright CD, Gaissert HA, Chang AC, Clinton S et al (2017) The society of thoracic surgeons general thoracic surgery database 2017 update on outcomes and quality. Ann Thorac Surg 103:1378–1383. https://doi.org/10.1016/j.athoracsur.2017.02.073 CrossRefPubMed

13.

Beck N, Hoeijmakers F, Wiegman EM, Smit JM, Schramel FM, Steup WH et al (2018) Lessons learned from the Dutch Institute for Clinical Auditing: the Dutch model for quality assurance in lung cancer treatment. J Thorac Dis. https://doi.org/10.21037/jtd.2018.04.56 CrossRefPubMedPubMedCentral

14.

Ten Berge MG, Beck N, Heineman DJ, Damhuis RAM, Steup WH, van Huijstee PJ et al (2018) Dutch lung surgery audit: a national audit comprising lung and thoracic surgery patients. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2018.03.049 CrossRefPubMed

15.

Dutch Institute for Clinical Auditing; verification project group. Data verification in the DLCA-S: Final report. 2016

16.

Multidisciplinary workinggroup on thoracic cancer. Dutch guideline for diagnosis and treatment of Non Small-Cell Lung Cancer 2015

17.

Bernard A, Ferrand L, Hagry O, Benoit L, Cheynel N, Favre J-P (2000) Identification of prognostic factors determining risk groups for lung resection. Ann Thorac Surg 70:1161–1167. https://doi.org/10.1016/S0003-4975(00)01853-1 CrossRefPubMed

18.

Spiegelhalter DJ (2005) Funnel plots for comparing institutional performance. Stat Med 24:1185–1202. https://doi.org/10.1002/sim.1970 CrossRefPubMed

19.

Fischer C, Lingsma H, Hardwick R, Cromwell DA, Steyerberg E, Groene O (2016) Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer. Br J Surg 103:105–116. https://doi.org/10.1002/bjs.9968 CrossRefPubMed

20.

Seder CW, Salati M, Kozower BD, Wright CD, Falcoz PE, Brunelli A et al (2016) Variation in pulmonary resection practices between the society of thoracic surgeons and the European society of thoracic surgeons general thoracic surgery databases. Ann Thorac Surg 101:2077–2084. https://doi.org/10.1016/j.athoracsur.2015.12.073 CrossRefPubMed

21.

Pagès PB, Mordant P, Renaud S, Brouchet L, Thomas PA, Dahan M et al (2017) Sleeve lobectomy may provide better outcomes than pneumonectomy for non–small cell lung cancer. A decade in a nationwide study. J Thorac Cardiovasc Surg 153:184–195. https://doi.org/10.1016/j.jtcvs.2016.09.060 CrossRefPubMed

22.

Damhuis RA, Maat AP, Plaisier PW (2015) Performance indicators for lung cancer surgery in the Netherlands. Eur J Cardiothorac Surg 47:897–903. https://doi.org/10.1093/ejcts/ezu329(discussion 903-4) CrossRefPubMed

23.

von Meyenfeldt EM, Gooiker GA, van Gijn W, Post PN, van de Velde CJ, Tollenaar RA et al (2012) The relationship between volume or surgeon specialty and outcome in the surgical treatment of lung cancer: a systematic review and meta-analysis. J Thorac Oncol 7:1170–1178. https://doi.org/10.1097/JTO.0b013e318257cc45 CrossRef

24.

Damhuis RAM, Schütte PR (1996) Resection rates and postoperative mortality in 7,899 patients with lung cancer. Eur Respir J 9:7–10. https://doi.org/10.1183/09031936.96.09010007 CrossRefPubMed

25.

Hoeijmakers F, Beck N, Wouters MWJM, Prins HA, Steup WH (2018) National quality registries: how to improve the quality of data? J Thorac Dis. https://doi.org/10.21037/jtd.2018.04.146 CrossRefPubMedPubMedCentral

26.

Wouters MWJM, Siesling S, Jansen-Landheer ML, Elferink MAG, Belderbos J, Coebergh JW et al (2010) Variation in treatment and outcome in patients with non-small cell lung cancer by region, hospital type and volume in the Netherlands. Eur J Surg Oncol 36:S83–S92. https://doi.org/10.1016/j.ejso.2010.06.020 CrossRefPubMed

27.

Rosado-de-Christenson ML, Frazier AA, Stocker JT, Templeton PA (1993) From the archives of the AFIP. Extralobar sequestration: radiologic-pathologic correlation. Radiographics 13:425–441. https://doi.org/10.1148/radiographics.13.2.8460228 CrossRefPubMed

28.

Gietelink L, van Groningen J, Tollenaar RAEM, Wouters MWJM, Marijnen CAM, Wouters MWJM et al (2017) Changes in nationwide use of preoperative radiotherapy for rectal cancer after revision of the national colorectal cancer guideline. Eur J Surg Oncol 43:1297–1303. https://doi.org/10.1016/j.ejso.2016.12.019 CrossRefPubMed

Title: Pneumonectomy for Lung Cancer Treatment in The Netherlands: Between-Hospital Variation and Outcomes
Authors: Naomi Beck
Thomas J. van Brakel
Hans J. M. Smit
David van Klaveren
Michel W. J. M. Wouters
Wilhelmina H. Schreurs
Publication date: 01-01-2020
Publisher: Springer International Publishing
Keywords: Lung Cancer
Lung Cancer
Pneumonectomy
Lung Cancer
Published in: World Journal of Surgery / Issue 1/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05190-w

At a glance: The STEP trials

Springer Medicine

Pneumonectomy for Lung Cancer Treatment in The Netherlands: Between-Hospital Variation and Outcomes

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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