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Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection

OBJECTIVES: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. METHODS: The National Cancer Database was queried from 2010 to 2018. Patients wi...

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Autores principales: Collins, Micaela L., Whitehorn, Gregory L., Mack, Shale J., Till, Brian M., Rshaidat, Hamza, Grenda, Tyler R., Evans, Nathaniel R., Okusanya, Olugbenga T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556949/
https://www.ncbi.nlm.nih.gov/pubmed/37808043
http://dx.doi.org/10.1016/j.xjon.2023.07.007
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author Collins, Micaela L.
Whitehorn, Gregory L.
Mack, Shale J.
Till, Brian M.
Rshaidat, Hamza
Grenda, Tyler R.
Evans, Nathaniel R.
Okusanya, Olugbenga T.
author_facet Collins, Micaela L.
Whitehorn, Gregory L.
Mack, Shale J.
Till, Brian M.
Rshaidat, Hamza
Grenda, Tyler R.
Evans, Nathaniel R.
Okusanya, Olugbenga T.
author_sort Collins, Micaela L.
collection PubMed
description OBJECTIVES: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. METHODS: The National Cancer Database was queried from 2010 to 2018. Patients with T1/T2 N0 M0 non–small cell lung cancer 2 cm or less who underwent wedge resection without neoadjuvant therapy were included. A wedge resection with no nodes sampled or with positive margins was categorized as a low-quality wedge. A wedge resection with 4 or more nodes sampled and negative margins was categorized as a high-quality wedge. Facility-specific variables were investigated via quartile analysis based on the overall volume and proportion of high-quality wedge or low-quality wedge resections performed. RESULTS: A total of 21,742 patients met inclusion criteria, 6390 (29.4%) of whom received a high-quality wedge resection. Factors associated with high-quality wedge resection included treatment at an academic center (3005 [47.0%] vs low-quality wedge 6279 [40.9%]; P < .001). The 30- and 90-day survivals were similar, but patients who received a high-quality wedge resection had improved 5-year survival (4902 [76.7%] vs 10,548 [68.7%]; P < .001). Facilities in the top quartile by volume of high-quality wedge resections performed 69% (4409) of all high-quality wedge resections, and facilities in the top quartile for low-quality wedge resections performed 67.6% (10,378) of all low-quality wedge resections. A total of 113 facilities were in the top quartile by volume for both high-quality wedge and low-quality wedge resections. CONCLUSIONS: High-quality wedge resections are associated with improved 5-year survival when compared with low-quality wedge resections. By volume, high-quality wedge and low-quality wedge resections cluster to a minority of facilities, many of which overlap. There is discordance between best practice guidelines and current practice patterns that warrants additional study.
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spelling pubmed-105569492023-10-07 Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection Collins, Micaela L. Whitehorn, Gregory L. Mack, Shale J. Till, Brian M. Rshaidat, Hamza Grenda, Tyler R. Evans, Nathaniel R. Okusanya, Olugbenga T. JTCVS Open Thoracic: Lung Cancer OBJECTIVES: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. METHODS: The National Cancer Database was queried from 2010 to 2018. Patients with T1/T2 N0 M0 non–small cell lung cancer 2 cm or less who underwent wedge resection without neoadjuvant therapy were included. A wedge resection with no nodes sampled or with positive margins was categorized as a low-quality wedge. A wedge resection with 4 or more nodes sampled and negative margins was categorized as a high-quality wedge. Facility-specific variables were investigated via quartile analysis based on the overall volume and proportion of high-quality wedge or low-quality wedge resections performed. RESULTS: A total of 21,742 patients met inclusion criteria, 6390 (29.4%) of whom received a high-quality wedge resection. Factors associated with high-quality wedge resection included treatment at an academic center (3005 [47.0%] vs low-quality wedge 6279 [40.9%]; P < .001). The 30- and 90-day survivals were similar, but patients who received a high-quality wedge resection had improved 5-year survival (4902 [76.7%] vs 10,548 [68.7%]; P < .001). Facilities in the top quartile by volume of high-quality wedge resections performed 69% (4409) of all high-quality wedge resections, and facilities in the top quartile for low-quality wedge resections performed 67.6% (10,378) of all low-quality wedge resections. A total of 113 facilities were in the top quartile by volume for both high-quality wedge and low-quality wedge resections. CONCLUSIONS: High-quality wedge resections are associated with improved 5-year survival when compared with low-quality wedge resections. By volume, high-quality wedge and low-quality wedge resections cluster to a minority of facilities, many of which overlap. There is discordance between best practice guidelines and current practice patterns that warrants additional study. Elsevier 2023-07-21 /pmc/articles/PMC10556949/ /pubmed/37808043 http://dx.doi.org/10.1016/j.xjon.2023.07.007 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Thoracic: Lung Cancer
Collins, Micaela L.
Whitehorn, Gregory L.
Mack, Shale J.
Till, Brian M.
Rshaidat, Hamza
Grenda, Tyler R.
Evans, Nathaniel R.
Okusanya, Olugbenga T.
Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection
title Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection
title_full Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection
title_fullStr Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection
title_full_unstemmed Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection
title_short Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resection
title_sort is wedge a dirty word? demographic and facility-level variables associated with high-quality wedge resection
topic Thoracic: Lung Cancer
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556949/
https://www.ncbi.nlm.nih.gov/pubmed/37808043
http://dx.doi.org/10.1016/j.xjon.2023.07.007
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