Surveying surgeon practices and perspectives on extent of intraoperative nodal evaluation in non–small cell lung cancer

JTCVS open Pub Date : 2025-04-01 DOI:10.1016/j.xjon.2025.01.010

Lyndon C. Walsh BA , Alessandro Brunelli MD , Biniam Kidane MD, MSc , Jazmin Eckhaus MBBS , Pierre Olivier Fiset MD, PhD , Jonathan D. Spicer MD, PhD , Mara B. Antonoff MD

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Abstract

Objective

The National Comprehensive Cancer Network and Commission on Cancer guidelines encourage surgeons to obtain tissue from 1 or more N1 and 3 N2 nodal stations during resection for non–small cell lung cancer. We aimed to characterize surgeons’ familiarity with and adherence to recommended guidelines and to elucidate factors influencing surgical practices globally.

Methods

A questionnaire was designed to assess surgeon behaviors regarding intraoperative nodal assessment decisions during lung cancer resection. Survey items included demographics, case-based scenarios, self-perceived behaviors regarding nodal decision-making, and knowledge-based questions regarding nodal assessment guidelines. The survey was distributed to the General Thoracic Surgical Club, European Society of Thoracic Surgeons, Canadian Association of Thoracic Surgeons, and Australian & New Zealand Society of Cardiac & Thoracic Surgeons.

Results

Altogether, 236 of 2396 surgeons (9.8%) from 46 countries responded. The majority were men (192/236) and general thoracic surgeons (204/236). Participants were subcategorized into North America (n = 96), Europe (n = 96), and All Other (n = 44). The importance of 4 variables that impact lymph node excision varied by region: length of procedure (P = .04), patient age (P = .0004), patient frailty (P = .0034), and institutional guidelines (P = .01). Surgeons stated that in patients who received neoadjuvant treatment, most would opt for a full lymphadenectomy. A total of 80.5% (n = 190) claimed familiarity with guidelines, yet only 56.4% (n = 133) could identify the guidelines.

Conclusions

The variables driving intraoperative decision-making for nodal dissection vary by region. Moreover, surgeons tend to overstate their knowledge of existing guidelines. To optimize cancer care around the world, education needs to be provided uniformly to drive positive patient outcomes.

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调查外科医生对非小细胞肺癌术中结节评估范围的做法和观点

目的：美国国家综合癌症网络和癌症委员会指南鼓励外科医生在非小细胞肺癌切除术中获取1个或多个N1和3个N2淋巴结站的组织。我们的目的是描述外科医生对推荐指南的熟悉程度和依从性，并阐明全球影响外科实践的因素。方法采用问卷调查法对肺癌切除术中外科医生在淋巴结评估决策方面的行为进行评估。调查项目包括人口统计、基于案例的情景、关于节点决策的自我感知行为，以及关于节点评估指南的基于知识的问题。该调查已分发给普通胸外科俱乐部、欧洲胸外科学会、加拿大胸外科学会和澳大利亚胸外科学会。新西兰心脏学会；胸的外科医生。结果来自46个国家的2396名外科医生中有236名（9.8%）做出了回应。大多数是男性（192/236）和普通胸外科医生（204/236）。参与者被细分为北美（n = 96）、欧洲（n = 96）和其他地区（n = 44）。影响淋巴结切除的4个变量的重要性因地区而异：手术时间（P = 0.04）、患者年龄（P = 0.0004）、患者虚弱程度（P = 0.0034）和机构指南（P = 0.01）。外科医生指出，在接受新辅助治疗的患者中，大多数人会选择全淋巴结切除术。总共80.5% （n = 190）声称熟悉指南，但只有56.4% （n = 133）能够识别指南。结论影响淋巴结清扫术中决策的因素因地区而异。此外，外科医生往往夸大他们对现有指导方针的了解。为了优化世界各地的癌症护理，需要统一提供教育，以推动积极的患者结果。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量