Intraoperative quality metrics and association with survival following lung cancer resection.

Abstract

8502 Background: Surgical resection remains the preferred treatment for functionally fit patients with clinical stage I non-small cell lung cancer (NSCLC). Process-based intra-operative quality metrics (QMs) are important for optimizing long-term outcomes following curative-intent resection. We sought to characterize overall survival using a novel surgical quality score. Methods: We performed a retrospective cohort study using a uniquely compiled dataset of US Veterans with clinical stage I NSCLC receiving definitive surgical treatment. Based on contemporary treatment guidelines, we defined five surgical QMs: timely surgery (within 12 weeks of diagnosis), minimally invasive approach, anatomic resection via lobectomy, adequate nodal sampling (≥10 nodes), and negative margin. Using a multivariable Cox proportional hazards model, we developed a surgical quality score reflecting the relationship between these QMs and overall survival (OS). We also examined the relationship between this score and disease-free survival (DFS). Results: The study included 9,628 Veterans undergoing surgical treatment between 2006 and 2016. QMs were met as follows: timely surgery (n=6,633, 68.9%), minimally invasive approach (n=3,986, 41.4%), lobectomy (n=6,843, 71.1%), adequate nodal sampling (n=3,278, 34.1%), and negative surgical margin (n=9,312, 96.7%). The median (IQR) follow-up was 6.2 (2.5-11.4) years. A normalized score from 0 (no QMs met) to 100 (all QMs met) was constructed, with higher scores reflecting progressively improved risk-adjusted OS (Table). The median (IQR) OS was 86.8 (37.8-149.6) months in the highest score quintile versus 25.3 (7.1-45.8) months in the lowest score quintile. Recurrence was detected in 2,268 (23.6%) patients. Higher surgical quality score was associated with improved DFS (multivariable-adjusted hazard ratio, aHR 0.494, 95% CI 0.245-0.997). Conclusions: Adherence to intra-operative QMs is associated with markedly improved overall and disease-free survival. Efforts to improve adherence to surgical QMs can dramatically improve patient outcomes following curative-intent resection of early-stage lung cancer. [Table: see text]