Abstract
Improving the quality of lung cancer care at a cost that can be sustained is a hotly debated issue. High-risk, low-volume procedures (such as lung resections) are believed to improve significantly when centralised in high-volume centres. However, limited evidence exists to support volume requirements in lung cancer surgery. On the other hand, there was no evidence that the number of lung resections affected either the short-term perioperative results or the long-term cost. Using data from an extensive nationwide registry, this study investigated the correlations between surgical volumes and selected perioperative outcomes. A retrospective analysis of a prospectively filled national registry that follows stringent quality assurance and security procedures was conducted to ensure data accuracy and security. Patients who underwent VATS lobectomy from 2014 to 2019 at the participating centres were included. Selected perioperative outcomes were reported. Total direct hospital cost is measured at discharge for hospitalisations with a primary diagnosis of lung cancer, hospital stay costs, and postoperative length of hospital stay after lobectomy. After the propensity score matched, centres were divided into three groups according to the surgical volume of the unit where VATS lobectomies were performed (high-volume centre: > 500 lobectomies; medium-volume centre: 200–500 lobectomies; low-volume centre: < 200 lobectomies). 11,347 patients were included and matched (low-volume center = 2890; medium-volume center = 3147; high-volume center = 2907). The mean operative time density plot (Fig. 1A) showed no statistically significant difference (p = 0.67). In contrast, the density plot of the harvested lymph nodes (Fig. 1B) showed significantly higher values in the high-volume centres (p = 0.045), albeit without being clinically significant. The adjusted rates of any and significant complications were higher in the low-volume centre (p = 0.034) without significantly affecting the length of hospital stay (p = 0.57). VATS lobectomies for lung cancer in higher-volume centres seem associated with a statistically significantly higher number of harvested lymph nodes and lower perioperative complications, yet without any significant impact in terms of costs and resource consumption. These findings may advise the investigation of the learning curve effect in a complete economic evaluation of VATS lobectomy in lung cancer.
The mean operative time density plot showed no statistically significant difference (p = 0.67)
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Data availability
The data presented in this study are available on request from the corresponding author.
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Acknowledgements
This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.
Members of the VATS group: Marco Alloisio (IRCCS Humanitas, Milano); Dario Amore (Monaldi Hospital, Napoli); Luca Ampollini (University Hospital, Parma); Claudio Andreetti (S. Andrea Hospital, Roma); Desideria Argnani (AUSL Romagna Teaching Hospital, Forlì); Guido Baietto (Maggiore della Carità Hospital, Novara); Alessandro Bandiera (S. Raffaele Hospital, Milano); Cristiano Benato (Borgo Trento Hospital, Verona); Mauro Roberto Benvenuti (Spedali Civili Hospital, Brescia); Alessandro Bertani (IRCCS ISMETT, Palermo); Luca Bertolaccini (IEO Hospital, Milano); Luigi Bortolotti (Humanitas Gavazzeni Hospital, Bergamo); Edoardo Bottoni (IRCCS Humanitas, Milano); Cristiano Breda (Ospedale dell’Angelo, Mestre); Pierpaolo Camplese (S. Maria Annunziata Hospital, Chieti); Paolo Carbognani (University Hospital, Parma); Giuseppe Cardillo (Forlanini Hospital, Roma); Caterina Casadio (Maggiore della Carità Hospital, Novara); Giorgio Cavallesco (University Hospital, Ferrara); Roberto Cherchi (Brotzu Hospital, Cagliari); Roberto Crisci (Università dell’Aquila, L’Aquila); Carlo Curcio (Monaldi Hospital, Napoli); Andrea Dell’Amore (University Hospital, Padua); Vittorio Della Beffa (S. Giovanni Bosco Hospital, Torino); Giampiero Dolci (S. Orsola Hospital, Bologna); Andrea Droghetti (ASST Mantova-Cremona, Mantova); Paolo A. Ferrari (Brotzu Hospital, Cagliari); Diego Fontana (S. Giovanni Bosco Hospital, Torino); Gaetano Gargiulo (S. Orsola Hospital, Bologna); Roberto Gasparri (IEO Hospital, Milano); Diego Gavezzoli (Spedali Civili Hospital, Brescia); Marco Ghisalberti (University Hospital, Siena); Michele Giovanardi (ASST Mantova-Cremona, Mantova); Alessandro Gonfiotti (Careggi University Hospital, Firenze); Francesco Guerrera (Molinette University Hospital, Torino); Andrea Imperatori (University Hospital, Varese); Maurizio Infante (Borgo Trento Hospital, Verona); Luciano Iurilli (ASL3 Liguria); Paolo Lausi (Molinette University Hospital, Torino); Fabio Lo Giudice (Ospedale dell’Angelo, Mestre); Francesco Londero (S. Maria delle Misericordia Hospital, Udine); Camillo Lopez (Vito Fazzi Hospital, Lecce); Luca Luzzi (University Hospital, Siena); Maurizio Mancuso (S. Antonio Hospital, Alessandria); Pio Maniscalco (University Hospital, Ferrara); Stefano Margaritora (University Hospital Gemelli, Roma); Elisa Meacci (University Hospital Gemelli, Roma); Giulio Melloni (Santa Croce Hospital, Cuneo); Angelo Morelli (S. Maria delle Misericordia Hospital, Udine); Felice Mucilli (S. Maria Annunziata Hospital, Chieti); Pamela Natali (Ospedale Policlinico, Modena); Giampiero Negri (S. Raffaele Hospital, Milano); Samuele Nicotra (University Hospital Padua); Mario Nosotti (Policlinico University Hospital Milano); Gianluca Pariscenti (S. Martino Hospital, Genova); Reinhold Perkmann (Bolzano Hospital, Bolzano); Fausto Pernazza (S. Antonio Hospital, Alessandria); Emanuele Pirondini (San Gerardo Hospital, Monza); Camilla Poggi (S. Andrea Hospital, Roma); Francesco Puma (University Hospital, Perugia); Majed Refai (Ospedali Riuniti, Ancona); Alessandro Rinaldo (Niguarda Hospital, Milano); Giovanna Rizzardi (Humanitas Gavazzeni Hospital, Bergamo); Lorenzo Rosso (Policlinico University Hospital, Milano); Nicola Rotolo (University Hospital, Varese); Emanuele Russo (IRCCS ISMETT, Palermo); Armando Sabbatini (Ospedali Riuniti, Ancona); Marco Scarci (San Gerardo Hospital, Monza); Lorenzo Spaggiari (IEO Hospital, Milano); Alessandro Stefani (Ospedale Policlinico, Modena); Piergiorgio Solli (Maggiore Hospital, Bologna); Corrado Surrente (Vito Fazzi Hospital, Lecce); Alberto Terzi (Negrar Hospital, Verona); Massimo Torre (Niguarda Hospital, Milano); Dami-ano Vinci (University Hospital, Perugia); Andrea Viti (Negrar Hospital, Verona); Luca Voltolini (Careggi University Hospital, Firenze); Gino Zaccagna (Mazzini Hospital, Teramo); Francesco Zaraca (Bolzano Hospital, Bolzano).
Marco Alloisio, Dario Amore, Luca Ampollini, Claudio Andreetti, Desideria Argnani, Guido Baietto, Alessandro Bandiera, Cristiano Benato, Mauro Roberto Benvenuti, Alessandro Bertani, Luca Bertolaccini, Luigi Bortolotti, Edoardo Bottoni, Cristiano Breda, Pierpaolo Camplese, Paolo Carbognani, Giuseppe Cardillo, Caterina Casadio, Giorgio Cavallesco, Roberto Cherchi, Roberto Crisci, Carlo Curcio, Andrea Dell’Amore, Vittorio Della Beffa, Giampiero Dolci, Andrea Droghetti, Paolo A. Ferrari, Diego Fontana, Gaetano Gargiulo, Roberto Gasparri, Diego Gavezzoli, Marco Ghisalberti, Michele Giovanardi, Alessandro Gonfiotti, Francesco Guerrera, Andrea Imperatori, Maurizio Infante, Luciano Iurilli, Paolo Lausi, Fabio Lo Giudice, Francesco Londero, Camillo Lopez, Luca Luzzi, Maurizio Mancuso, Pio Maniscalco, Stefano Margaritora, Elisa Meacci, Giulio Melloni, Angelo Morelli, Felice Mucilli, Pamela Natali, Giampiero Negri, Samuele Nicotra, Mario Nosotti, Gianluca Pariscenti, Reinhold Perkmann, Fausto Pernazza, Emanuele Pirondini, Camilla Poggi, Francesco Puma, Majed Refai, Alessandro Rinaldo, Giovanna Rizzardi, Lorenzo Rosso, Nicola Rotolo, Emanuele Russo, Armando Sabbatini, Marco Scarci, Lorenzo Spaggiari, Alessandro Stefani, Piergiorgio Solli, Corrado Surrente, Alberto Terzi, Massimo Torre, Dami-ano Vinci, Andrea Viti, Luca Voltolini, Gino Zaccagna, Francesco Zaraca
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According to the International Conference on Harmonization Guidelines for Good Clinical Practice, the data were collected anonymously. The ethical committee approved the registry (81/2014/O/Oss). The Institutional Review Board, informed of the database extraction, did not require approval because of the study’s retrospective nature.
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Bertolaccini, L., Prisciandaro, E., Uslenghi, C. et al. The role of the surgical volume for clinical outcomes in VATS lobectomy for lung cancer: a national large database multicenter analysis. Updates Surg (2023). https://doi.org/10.1007/s13304-023-01723-0
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DOI: https://doi.org/10.1007/s13304-023-01723-0