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Impact of Number of Lymph Nodes in Lung Cancer Resection on Survival: A 10-Year Experience in a Department of Defense Institution to Include Quality of Lymph Node Sampling, Operative Procedure, Staging, and 5-year Survival

Bethany M Heidenreich, CPT, DO, Andrew S Durkee, CPT, DO, Julia O Bader, PhD, Vincent J Mase Jr., LTC, MD. William Beaumont Army Medical Center

Objectives: Assess a 10-year experience at our institution with regard to thoracic oncology, to include quality of regional lymph node (RLN) dissection as compared to the Commission on Cancer (CoC) surveillance measure 10RLN, stage, operative procedure, and the impact of number of RLN examined on 5-year survival.

Methods: A 10-year query of our Automated Central Tumor Registry (ACTUR) database was performed to identify all stages of lung cancer patients who received lung resection as part of their treatment at our institution from 2005 through 2015. Initial evaluation was performed to report the general demographics of our institution with regard to thoracic surgical oncology over the past 10 years. The data was further refined to evaluate only cases of stage I and II resected NSCLC diagnosed since 2010, according to the parameters of the CoC surveillance measure 10RLN. Logistic regression analysis was performed to determine whether the examination of ?10 RLN, is associated with increased odds of survival. Survival curves were estimated using the Kaplan-Meier method. The log rank test and Cox proportional hazard analysis were performed to evaluate the effect of number of RLN examined on survival.

Results: 83 cases performed at our institution from 2005-2015 included the following surgeries: 21 wedge resections, 56 lobectomies, and 6 pneumonectomies. The demographics were predominantly male (77.1%), white (80.7%), age 60-69 (44.6%), with a positive smoking history (49.4%). The cancers were pathologically stage I (57.8%), stage II (22.9%), stage III (6.0%), stage IV (4.8%), and unknown (8.4%). The majority of the cancers were poorly differentiated (50.6%) adenocarcinomas (56.6%). Median survival was 5.7 years. The median RLN examined was 7. 70% of resections at our institution from 2010-2015, for NSCLC stage I and II, did not meet the CoC surveillance measure 10RLN. Logistic regression analysis comparing ?10 versus <10 RLN for predicting 5-year survival, and Cox models adjusting for sex, age, histology and surgery showed no significance. Kaplan-Meier survival curves were also not significant.

Conclusions: A majority of resections performed at our institution did not meet the CoC surveillance measure of ?10 RLN examined in stage I and II resected NSCLC. Quality improvement projects are currently planned with our cancer center. The number of RLN examined had no significant impact on survival. However, the study was underpowered. We are currently conducting a DoD-wide, multi-center analysis of these same factors. This investigation should be appropriately powered to determine if this surveillance measure correlates with improved survival.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88297

Program Number: MSS18

Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations

Presentation Type: MSSPodium

8

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