Patterns of surgical care of lung cancer patients
Patterns of surgical care of lung cancer patients
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DOI：
10.1016/j.athoracsur.2005.06.071
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发表时间：
2005-12-01
影响因子：
4.6
通讯作者：
Stewart, AK
中科院分区：
文献类型：
--
作者：
Little, AG;Rusch, VW;Stewart, AK
背景本调查旨在确定非小细胞肺癌（NSCLC）患者的外科护理模式。2001年，美国外科医师学会对729家医院进行了一项患者护理调查，以检索NSCLC患者的病史、评估、病理和手术治疗信息。40，090例患者符合入选标准：其中11，668例（29.1%）接受手术治疗; 74.2%单独治疗，25.8%作为多模式治疗的一部分。在这些患者中，59.5%处于I期，17.5%处于II期，17.0%处于III期，6.0%处于IV期。手术患者人口统计学如下：55%男性和45%女性; 46.8% 70岁或以上; 76.3%有显著合并症。肿瘤特征：鳞状28%，腺癌37.6%，其他34.4%。分期：除放射学检查外，27.1%的手术患者术前进行了纵隔镜检查，仅46.6%的手术患者进行了淋巴结活检。手术方式：肺楔形切除15.6%，肺叶切除70.8%，全肺切除13.6%。手术切缘阳性率为7.8%，但只有65.2%有冰冻切片分析。围手术期死亡率为5.2%，但在非输血患者中为4.0%，在输血患者中为12.7%，在高容量医院（每年超过90例手术）中为3.2%，在低容量医院中为4.8%（p < 0.001）。(1)接受NSCLC手术的患者为患有严重并发症的老年人。(2)与以前相比，更多的患者是女性和腺癌。(3)纵隔镜检查很少进行，淋巴结活检不到50%。(4)肺叶切除术是最常见的手术，手术切缘阳性也很常见。(5)手术死亡率是合理的，但输血是风险增加的标志，在高容量医院结局上级。(6)容量较大的医院围手术期死亡较少。
Background. This survey was performed to determine the patterns of surgical care provided patients with non-small cell lung carcinoma (NSCLC).Methods. In 2001, the American College of Surgeons carried out a patient care survey of 729 hospitals to retrieve information of NSCLC patients' history, evaluation, pathology, and surgical treatment.Results. Inclusion criteria were met by 40,090 patients: of whom 11,668 (29.1%) were treated surgically; 74.2% alone and 25.8% as part of multimodality therapy. Of these patients, 59.5% were in stage I, 17.5% in stage II, 17.0% in stage III, and 6.0% in stage IV. Surgery patient demographics were the following: 55% male and 45% female; 46.8% 70 years or older; and 76.3% had significant comorbidities. Tumor characteristics: squamous 28%, adenocarcinoma 37.6%, other 34.4%. Staging: in addition to radiologic examinations, preoperative mediastinoscopy was performed in 27.1% of operated patients with node biopsy in only 46.6% of these procedures. Operations: wedge resection 15.6%, lobectomy 70.8%, pneumonectomy 13.6%. Surgical margins were positive in 7.8%, but only 65.2% had frozen section analysis. Perioperative mortality was 5.2%, but was 4.0% in nontransfused patients and 12.7% in transfused patients and was 3.2% in high-volume (more than 90 operations per year) versus 4.8% in low-volume hospitals (p < 0.001).Conclusions. (1) Patients being operated for NSCLC are elderly with significant cornorbid conditions. (2) More patients than previously are female and have adenocarcinoma. (3) Mediastinoscopy is infrequently performed and lymph nodes are biopsied in less than 50% of them. (4) Lobectomy is the most common operation, and positive surgical margins are too frequent. (5) Operative mortality is reasonable but transfusion is a marker for increased risk and outcomes are superior in high-volume hospitals. (6) Hospitals with higher volume had fewer perioperative deaths.