When the life of a non-small cell lung cancer (NSCLC) patient relies on a surgical procedure, physicians must make the most informed decision as to which surgical technique should be used. Studies show that patients receiving a pneumonectomy have a three-times higher chance of mortality than other types of resection such as lobectomy, but the level of experience a physician has with a surgery may be the ultimate deciding factor. A study presented at the 95th American Association for Thoracic Surgery (AATS) Annual Meeting by Christian J. Finley, MD, MPH, of McMaster University in Canada identified that surgeon experience strongly predicts the type of resection procedure the surgeon conducts.
“If a surgeon with high surgical volumes is less likely to perform higher risk pneumonectomy procedures than one with lower volumes, this may translate to a significant reduction in adverse events,” stated Dr. Finley, in a news release from AATS. “Surgeon volume should be considered an important component in how care is delivered in this population.”
As described by the presentation, entitled “The Effect of Surgeon Volume on Procedure Selection in Non-Small Cell Lung Cancer Surgery,” data from 8,070 NSCLC patients operated on by 124 physicians at 45 institutions in Ontario were analyzed to determine the effect of surgeon comfort with procedures and the chosen procedure. There was a strong association between surgeon volume and choice of procedure. Surgeons who perform more surgeries (who are therefore more comfortable with surgery) are less likely to select the high-risk pneumonectomy.
Pneumonectomies are high-risk because the whole lung is removed during surgery. This leads to high morbidity and mortality rates, compared to procedures such as lobectomies and sub-lobar resections, which remove only part of the lung. These safer procedures are more technically difficult and require a high level of surgical experience.
“Only over the past decade have surgeon-specific factors such as experience, training, and volume been identified and examined as other important determinants of outcomes in lung cancer patients,” said Dr. Finley. “This study possibly provides more evidence that surgeries are more likely to be successful if they are performed by surgeons who have a high annual case volume.” Identifying and recognizing these other factors of surgical choice may lead to more informed decisions for NSCLC patient care.