Intraoperative oncologic staging and outcomes for lung cancer resection vary by surgeon specialty

Abstract

Background: In the United States the majority of lung cancer resections are performed by general surgeons, although surgeons specializing in thoracic surgery have demonstrated superior perioperative and long-term oncologic outcomes. Why these differences exist has not been well studied. We hypothesized that the completeness of intraoperative oncologic staging may explain some of these differences.

Methods: The Nationwide Inpatient Sample (NIS) database was used to review 222,233 patients with primary lung cancer treated surgically with wedge resection, segmentectomy, lobectomy, or pneumonectomy from 1998 to 2007. Surgeons were classified as general thoracic surgeons if they performed greater than 75% general thoracic operations and less than 10% cardiac operations; they were classified as cardiac surgeons if they performed greater than 10% cardiac operations; they were classified as general surgeons if they performed less than 75% thoracic operations and less than 10% cardiac operations. The main outcome measure was the performance of lymphadenectomy or mediastinoscopy during the same admission as the cancer resection.

Results: The overall lymphadenectomy rate was 56% (n = 125,115) and was highest for general thoracic surgeons at 73% (n = 13,313), followed by 55% (n = 65,453) for general surgeons, and 54% (n = 46,349) for cardiac surgeons (p < 0.0001). General surgeons had a significantly higher risk for in-hospital mortality (odds ratio [OR], 1.47; confidence interval [CI], 1.14 to 1.90; p = 0.003) and postoperative complications (OR, 1.17; CI, 1.00 to 1.36; p = 0.043) compared with general thoracic surgeons.

Conclusions: Surgeon specialty impacts the adequacy of oncologic staging in patients undergoing resection for primary lung cancer. Specifically, general thoracic surgeons performed intraoperative oncologic staging significantly more often than did their general surgeon and cardiac surgeon counterparts while achieving significantly lower in-hospital mortality and complication rates.