NESS - Quantified Improvements in Surgical Therapy for Non-Small Cell Lung Cancer Within A Collaborative Multidisciplinary Thoracic Oncology Program

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Quantified Improvements in Surgical Therapy for Non-Small Cell Lung Cancer Within A Collaborative Multidisciplinary Thoracic Oncology Program
*Clinton Protack, *Jia Liu, *Daniel Boffa, *Frank Detterbeck, *Anthony Kim
Yale University, New Haven, CT

Objective:
To identify the benefits of a multidisciplinary tumor board (MDTB) within a structured thoracic oncology program (TOP) in the management of patients with non-small cell lung cancer (NSCLC).
Design:
A retrospective study of patients undergoing thoracic lobectomy for NSCLC from 7/2004 to 6/2005 (pre-MDTB) and 7/2008 to 6/2009 (post-MDTB) was conducted.
Setting:
Academic medical center.
Interventions:
Open and thorascopic (VATS) lobectomy.
Main Outcome Measures:
Performance of clinical staging, utilization of mediastinoscopy and bronchoscopy, and survival.
Results:
166 patients were identified, pre-MDTB (n=67, 40%) and post-MDTB (n=99, 60%). Post-MDTB patients were more likely to be clinically staged (70% vs 42%, p<0.001), undergo mediastinoscopy (15% vs 41%, p<0.001) and bronchoscopy (25% vs 43%, p=0.021), and VATs resection (15% vs 57%, p<0.001). Post-MDTB lobectomies were associated with a greater number of lymph nodes procured (14 vs 8, p<0.0001). Among patients clinically staged, pathologic stages were concordant in both groups, 61% vs 55% (p=ns). Surprise N2 disease occurred in nearly half of the post-MDTB patients with pathologic stage III disease but this difference was not significant (33% and 58%, p=ns). Among patients undergoing mediastinoscopy and lobectomy, post-MDTB patients had greater survival (3-year: 72% vs 33%, p=0.012), Figure 1.
Conclusions:
Post-MDTB lobectomy is associated with increased clinical staging, greater utilization of mediastinoscopy and bronchoscopy, VATS approach, greater number of lymph nodes procured, and decreased length of stay. Direct and indirect benefits of a MDTB within a structured TOP positively affect surgical outcomes and warrant greater study of other factors.

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