Quality Improvements in Lung Cancer Surgery and Tumor Pathology Extend Survival After Surgery

ALEXANDRIA, Va. - New research showed that improving surgical and pathological techniques can improve overall survival for a high-risk population of patients with lung cancer. These findings will be presented at the 2024 American Society of Clinical Oncology (ASCO) Quality Care Symposium, taking place September 27-28, 2024, in San Francisco, California.

About the Study

At 14 hospitals, which covered almost all lung cancer surgeries in a defined population within the Mississippi Delta region, researchers implemented two interventions over four periods to improve the quality of surgery and the examination of lymph nodes:

• Lymph node specimen collection kit. This kit helped remind surgeons to retrieve the hilar and specific mediastinal lymph nodes during surgery, as well as standardize communication and transport of retrieved lymph nodes to pathology teams. The hilar and mediastinal lymph nodes play an important role in staging lung cancer and examining them can help guide treatment after surgery.

• Novel gross dissection protocol. This protocol helped pathology teams yield and examine more intrapulmonary lymph nodes from the lung specimen. Examining these lymph nodes can help with staging and guiding treatment after surgery.

During Period 1 (2004 to 2008), baseline data was collected with no interventions. During Period 2 (2009 to 2013), researchers introduced continuous quality feedback and monitoring and began implementing the lymph node specimen collection kit. During Period 3 (2014 to 2018), the lymph node collection kit was implemented at any hospital in the region that had performed 5 or more lung cancer surgeries every year. During Period 4 (2019 to 2023), the gross dissection protocol was implemented.

Key Findings

• During these four periods, there were 7,240 lung cancer surgeries in the participating hospitals. With each period, the number of complete resections (using a stringent definition) increased from 0% in Period 1 to 9%, 21%, and 32% in Periods 2 to 4, respectively.

• The quality of the surgeries was also measured with the American College of Surgeons Operative Standard 5.8. The number of surgeries that met this standard increased throughout each period as well (from 4% for Period 1 to 24%, 50%, and 67%, respectively).

• The number of patients who died within 120 days (about 4 months) after surgery also decreased, from 10% in Period 1 to 4% in Period 4.

• From Periods 1 to 4, the 3-year overall survival rates were 60%, 64%, 70%, and 79%, respectively, and the 5-year overall survival rates were 48%, 52%, 58%, and 70%, respectively.

• The interventions also lowered the risk of death for patients over time. When compared to the baseline era, mortality was reduced 9% by 2013 and 51% by 2023.

• The better surgical quality and pathological practices helped doctors improve care for lung cancer patients, including streamlined care during surgery and after.

"These findings are important because they show that surgical outcomes of lung cancer patients can be drastically improved over time. While we believe the improvements seen in this study are likely multi-factorial, among the strongest reasons is linkage to improvements in the quality of care. We highlight the impact of disseminating our specific quality improvement initiatives on improving patient outcomes and set new expectations for population-level quality and outcomes of the surgical care of lung cancer patients," said lead study author Olawale Akinbobola, MPH, Research Scientist, Analyst, Thoracic Oncology Research at Baptist Cancer Center in Memphis, TN.

Next Steps

Researchers will study the biological factors involved in this survival improvement and how to determine which patients may benefit from additional treatment before and after surgery.