Walsh Lyndon C, Brunelli Alessandro, Kidane Biniam, Eckhaus Jazmin, Fiset Pierre Olivier, Spicer Jonathan D, Antonoff Mara B
Department of Cardiovascular and Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Thoracic Surgery, Montréal General Hospital, Montréal, Québec, Canada.
JTCVS Open. 2025 Jan 31;24:376-382. doi: 10.1016/j.xjon.2025.01.010. eCollection 2025 Apr.
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.
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.
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 ( = .04), patient age ( = .0004), patient frailty ( = .0034), and institutional guidelines ( = .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.
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.
美国国立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从1个或更多N1和3个N2淋巴结站获取组织。我们旨在描述外科医生对推荐指南的熟悉程度和遵循情况，并阐明全球影响手术操作的因素。
设计了一份问卷，以评估外科医生在肺癌切除术中关于术中淋巴结评估决策的行为。调查项目包括人口统计学、基于病例的情景、关于淋巴结决策的自我认知行为以及关于淋巴结评估指南的基于知识的问题。该调查分发给了普通胸外科俱乐部、欧洲胸外科医师协会、加拿大胸外科医师协会以及澳大利亚和新西兰心胸外科医师协会。
来自46个国家的2396名外科医生中共有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）和所有其他地区（n = 44）。影响淋巴结切除的4个变量的重要性因地区而异：手术时长（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）。外科医生表示，在接受新辅助治疗的患者中，大多数会选择进行完整的淋巴结清扫术。共有80.5%（n = 190）的人声称熟悉指南，但只有56.4%（n = 133）能够识别这些指南。
驱动术中淋巴结清扫决策的变量因地区而异。此外，外科医生往往夸大他们对现有指南的了解。为了在全球范围内优化癌症治疗，需要统一提供教育以推动积极的患者治疗结果。
