Virtual Library

Start Your Search

Luc Te Marvelde

Author of

  • +

    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P1.16-58 - Hospital Lung Surgery Volume and Patient Outcomes in Victoria (ID 12674)

      16:45 - 18:00  |  Author(s): Luc Te Marvelde

      • Abstract


      Surgical resection remains the primary curative option for early stage non-small cell lung cancer (NSCLC) with lobectomies considered the gold standard due to a reduction in local recurrence and improved overall survival. There has been growing evidence of an association between patient outcomes and the number of cancer surgeries performed at a hospital since the seminal paper by Luft et al in 1979.

      To our knowledge, there are no Australian data on hospital cancer surgery volumes and patient outcomes by procedure, and few data worldwide on specific lung surgery procedures and outcomes. We evaluated the relationship between hospital NSCLC surgery volume and patient outcomes in Victoria.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Victorians with a primary diagnosis of NSCLC between 2008 and 2014 were identified in the Victorian Cancer Registry (n=15,469), 3,420 (22%) of whom had surgery. Primary outcome was death within 90 days of surgery and secondary outcomes were overall survival, use of postoperative ventilation, ≥24hours spent in ICU and length of stay >17days. Hospital volume was measured as the average number of lung surgeries performed per year, with quartiles Q1: 1-17, Q2: 18-34, Q3: 35-58 and Q4: 59+.

      4c3880bb027f159e801041b1021e88e8 Result

      57% (1,941/3,420) lung cancer patients underwent lobectomy, 38% (1,299/3,420) sub-lobar resection and 5% (180/3,420) pneumonectomy. The overall 90-day mortality after lung surgery was 3.5%, and was 2.6% for patients undergoing lobectomy compared with 4.5% for those undergoing sub-lobar resection. There was no difference in 90-day mortality between low- and high-volume centres regardless of procedure. Patients operated in lower volume centres had more admissions to ICU ≥24hours (Q1. 55% vs. Q4. 11%, p-trend <0.001). Median overall survival was 6.2 years, 5.4 years and 5.8 years for lobectomy, sub-lobar resection and pneumonectomy, respectively. The distribution of ASA scores differed between patients attending public and private hospitals. A higher proportion of patients attending private hospitals (19%) had an ASA score of 4 compared with patients attending a public hospital (9%).

      8eea62084ca7e541d918e823422bd82e Conclusion

      We observed no evidence of survival differences between lung cancer patients attending low- and high-volume hospitals for surgery, regardless of surgical procedure. Median overall survival in Victorian is substantially better compared to interstate and international data. Of interest, a higher proportion of patients had an ICU admission ≥24hours in lower volume centres. We also observed a higher proportion of patients with an ASA score of 4 in private hospitals compared to public hospitals; the reasons for this are unclear and warrant further investigation.