Department of Surgery, Division of Cardiothoracic Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Ann Thorac Surg. 2011 Dec;92(6):1958-63; discussion 1963-4. doi: 10.1016/j.athoracsur.2011.05.120. Epub 2011 Oct 1.
In the United States the majority of lung cancer resections are performed by general surgeons, although surgeons specializing in thoracic surgery have demonstrated superior perioperative and long-term oncologic outcomes. Why these differences exist has not been well studied. We hypothesized that the completeness of intraoperative oncologic staging may explain some of these differences.
The Nationwide Inpatient Sample (NIS) database was used to review 222,233 patients with primary lung cancer treated surgically with wedge resection, segmentectomy, lobectomy, or pneumonectomy from 1998 to 2007. Surgeons were classified as general thoracic surgeons if they performed greater than 75% general thoracic operations and less than 10% cardiac operations; they were classified as cardiac surgeons if they performed greater than 10% cardiac operations; they were classified as general surgeons if they performed less than 75% thoracic operations and less than 10% cardiac operations. The main outcome measure was the performance of lymphadenectomy or mediastinoscopy during the same admission as the cancer resection.
The overall lymphadenectomy rate was 56% (n = 125,115) and was highest for general thoracic surgeons at 73% (n = 13,313), followed by 55% (n = 65,453) for general surgeons, and 54% (n = 46,349) for cardiac surgeons (p < 0.0001). General surgeons had a significantly higher risk for in-hospital mortality (odds ratio [OR], 1.47; confidence interval [CI], 1.14 to 1.90; p = 0.003) and postoperative complications (OR, 1.17; CI, 1.00 to 1.36; p = 0.043) compared with general thoracic surgeons.
Surgeon specialty impacts the adequacy of oncologic staging in patients undergoing resection for primary lung cancer. Specifically, general thoracic surgeons performed intraoperative oncologic staging significantly more often than did their general surgeon and cardiac surgeon counterparts while achieving significantly lower in-hospital mortality and complication rates.
在美国，大多数肺癌切除术由普通外科医生完成，尽管专门从事胸外科的外科医生已经证明了围手术期和长期肿瘤学结果更优。为什么会存在这些差异尚未得到充分研究。我们假设术中肿瘤分期的完整性可能可以解释其中的一些差异。
使用全国住院患者样本（NIS）数据库，回顾了 1998 年至 2007 年间接受楔形切除术、节段切除术、肺叶切除术或全肺切除术治疗的 222233 例原发性肺癌患者。如果外科医生进行的胸外科手术超过 75%，而心脏手术少于 10%，则将其归类为普通胸外科医生；如果进行的心脏手术超过 10%，则将其归类为心脏外科医生；如果进行的胸外科手术少于 75%，而心脏手术少于 10%，则将其归类为普通外科医生。主要观察指标是在癌症切除的同一住院期间进行淋巴结切除术或纵隔镜检查。
总体淋巴结切除术率为 56%（n=125115），普通胸外科医生的比率最高为 73%（n=13313），其次是普通外科医生的 55%（n=65453），心脏外科医生的 54%（n=46349）（p<0.0001）。与普通胸外科医生相比，普通外科医生的院内死亡率（优势比[OR]，1.47；置信区间[CI]，1.14 至 1.90；p=0.003）和术后并发症（OR，1.17；CI，1.00 至 1.36；p=0.043）的风险显著更高。
外科医生的专业水平会影响接受原发性肺癌切除术的患者的肿瘤分期充分性。具体来说，普通胸外科医生进行术中肿瘤分期的频率明显高于普通外科医生和心脏外科医生，同时实现了更低的院内死亡率和并发症发生率。
