The following is a summary of “Institution-Level Evolution of Lung Cancer Resection Quality With Implementation of a Lymph Node Specimen Collection Kit,” published in the July 2023 issue of the Thoracic Oncology by Akinbobola et al.

Adding a lymph node kit to lung cancer surgery enhances patient outcomes, but the institution-level effects are unproven. Using an institutional stepped-wedge implementation study design, researchers compared the quality of lung cancer resections between institutions in the implementation and postimplementation phases of kit deployment and, within implementing institutions, between resections performed without the kit and those performed with the kit. Rates of nonexamination of lymph nodes, mediastinal lymph nodes, and achievement of American College of Surgeons Operative Standard 5.8 served as benchmarks. 

They report adjusted ORs (aORs) at the institutional level to meet quality benchmarks. From 2009 to 2020, three pre-implementation hospitals performed 953 resections, while eleven implementing hospitals performed 4,013 resections, 58% without the equipment and 42% with it. In implementing institutions and kit cases, quality was higher. Compared to pre-implementation institutions, the aOR for lymph node nonexamination was 0.62 (0.49–0.8, P= 0.002), nonexamination of mediastinal lymph nodes was 0.56 (0.47–0.68, P<0.0001), and attainment of Operative Standard 5.8 was 7.3 (5.6–9.4, P<0.0001); the aORs for kit cases were 0.01 (0.001–0.06), 0.08 (0.06–0.11), and 11.6 (9.9–13.7), respectively (p < 0.0001 for all). Surgical quality remained persistently low in pre-implementation institutions but progressively improved in institutions that adopted kits. 

In implementing institutions, the quality of resections performed with the kit was uniformly high, whereas the quality of resections performed without the kit approximated that of implementing institutions. In implementing institutions, the 5-year overall survival rate was 61% with the kit versus 51% without it (P<0.001). A lymph node specimen collection kit enhanced the quality of curative lung cancer resection at the institutional level.

Source: sciencedirect.com/science/article/abs/pii/S1556086423001910