Still, there is a lack of information on outcomes as they relate to facility volume, despite segmental resection becoming increasingly popular for treating early-stage non-small cell lung cancer. This research aims to clarify the connection between segmentectomy success rates, patient mortality, and hospital throughput. With the help of the National Cancer Database, a retrospective cohort study was conducted. Segmentectomies performed on patients with stage I illness between 2004 and 2015 were considered. Each year, researchers counted the number of segmental resections performed at each facility; those that performed more than the median number were labeled “high volume,” and that designation stuck throughout the research. The 5 year survival and outcomes were compared using propensity score matching.
Included were 681 facilities with a total of 2,481 segmentectomies. It was shown that high-volume centers were more likely to use less invasive procedures and had lower rates of patients switching to more invasive ones. Mortality rates at 30 and 90 days were similar between the groups (1.2% vs. 2.6%, P=.03), while readmission rates were higher for the latter group. Lymph nodes were more likely to be sampled at high-volume institutions (88.5% vs. 80.7%, P<.01), and patients had fewer positive margins (1.3% vs. 2.7%, P=.03) when treated at these facilities. It was found that the volume of the facility did not affect the likelihood of patients being upstaged (4.6% vs. 3.3%, P=.21).
Patients treated at high-volume centers had a higher 5-year survival rate than those who were not (69.5% vs. 66.4%, P=.014), but this difference was no longer statistically significant after adjustment for propensity scores (68.0% vs. 67.9%, P=.172). The utilization of a minimally invasive method, the presence of negative margins, and the length of time until death after 90 days all improve when segmentectomy is performed in high-volume centers.