Number of lung resections performed and long-term mortality rates of patients after lung cancer surgery: evidence from an Italian investigation.

Federico Rea, Francesca Ieva, Ugo Pastorino, Giovanni Apolone, Sandro Barni, Luca Merlino, Matteo Franchi, Giovanni Corrao

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate. METHODS: The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31-95) and high (textgreater95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS: The 1-year and 5-year survival rates of cohort members were 903volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (-13 951031 and high (-26 045. Sensitivity analyses revealed that the association was consistent. CONCLUSIONS: Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
Original languageEnglish
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number1
Publication statusPublished - Jul 1 2020

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