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Characteristics of High-Volume Lung Segmentectomy Hospitals
Shale J. Mack, Brian M. Till, Charles Huang, Uzma Rahman, Darshak Thosani, Tyler Grenda, Nathaniel R. Evans, III, Olugbenga T. Okusanya.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

BACKGROUND
Segmentectomy has gained favor in treating early-stage non-small cell lung cancer (NSCLC). Operations at high-volume centers are largely associated with improved outcomes. Limited data exists on outcomes at high-volume segmentectomy centers (HVSC) as compared to low-volume segmentectomy centers (LVSC).
METHODS
A retrospective cohort analysis was completed using the National Cancer Database (NCDB) for patients with clinical stage I NSCLC who underwent segmentectomy from 2004-2015. Propensity score matching was used to compare 5-year overall survival (OS) for patients at HVSC to those at LVSC. Patients were matched on 10 patient and tumor characteristics. Volume of facility was determined per annum, with facilities performing greater than the median number of segmental resections deemed HVSC. Kaplan-Meier analyses with log-rank tests were used to compare OS.
RESULTS
768 centers performing 4,410 segmentectomies were identified. HVSC had higher rates of minimally-invasive approaches and lower conversion rates. There was no difference in readmission, 30-day and 90-day mortality. HVSC were more likely to sample lymph nodes (88.4% vs 80.8%, P<0.01) and had a higher mean number of lymph nodes sampled (13.3 vs 11.0, P<0.01). Nodal upstaging was no different. HVSC were less likely to have positives margins (2.8% vs 4.3%, P<0.01). On Kaplan-Meier analyses, higher 5-year OS was associated with receipt of surgery at HVSC (61.4% vs. 57.8%, P<0.01). Propensity matching selected 3,512 patients with 1,756 in each cohort. Improved OS was associated with treatment at HVSC (59.8% vs. 58.4%, P=0.04).
CONCLUSIONS
Segmenectomy performed at HVSC is associated with minimally-invasive approach, improved nodal harvest and margins, and improved 5-year survival.


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