Brendon Stiles

M.D.

Weill Cornell Medicine

Associate Professor of Cardiothoracic Surgery

NLST (Learn more about this study)

NLST-281

Feb 7, 2017

Surgical approach and outcomes in NLST patients with positive screening CT

In this study, we propose to evaluate the surgical approach (thoracotomy vs. thoracoscopy) and the type of resection (wedge, segmentectomy, lobectomy, pneumonectomy) utilized for patients with screen-detected lung nodules in the NLST data set and to determine survival in surgically resected lung cancer patients. We hypothesize that thoracotomy was over-utilized compared to more modern series of screen-detected lung nodules and that the use of thoracotomy is associated with increased perioperative morbidity and mortality. Furthermore, we seek to perform exploratory studies on the “quality” of surgery in patients with screen-detected nodules based upon current guidelines: anatomic resection, operation within 8 weeks of diagnosis, negative surgical margins, and sampling of >/= 10 lymph nodes. We hypothesize that adherence to quality measures will be associated with improvements in survival in patients with cancer. The study will also allow us to evaluate the use of surgery in patients found not to have lung cancer. Significant attention has been drawn to the potential harm caused to these patients with the advent of widespread CT screening for lung cancer. We will evaluate the proportion of patients who went to the OR without a tissue diagnosis, surgical approach and resection type for the operations they underwent, as well as specific complications relating to each. We will also seek to determine whether these patients would have been offered a diagnostic procedure or operation based upon current Lung-RADS criteria.