{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:10:53Z","timestamp":1776312653597,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T00:00:00Z","timestamp":1587427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K24 CA201543\u201001"],"award-info":[{"award-number":["K24 CA201543\u201001"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Clinical outcomes for resected early\u2010stage non\u2010small cell lung cancer (NSCLC) are superior at high\u2010volume facilities, but reasons for these differences remain unclear. Understanding these differences and optimizing outcomes across institutions are critical to the management of the increasing incidence of these cases. We evaluated the extent to which surgical best practices account for resected early\u2010stage NSCLC outcome differences between facilities according to case volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective cohort study for clinical stage 1 or 2 NSCLC undergoing surgical resection from 2004 to 2013 using the National Cancer Database (NCDB). Surgical best practices (negative surgical margins, lobar or greater resection, lymph node (LN) dissection, and examination of\u00a0&gt;\u00a010 LNs) were compared between the highest and lowest quartile volumes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 150,179 patients were included in the cohort (89% white, 53% female, median age 68\u00a0years). In a multivariate model, superior overall survival (OS) was observed at highest volume centers compared to lowest volume centers (hazard ratio (HR)\u00a0=\u00a00.89; 95% CI, 0.82\u20100.96; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.002). After matching for surgical best practices, there was no significant OS difference (HR\u00a0=\u00a00.95; 95% CI, 0.87\u20101.05; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.32). Propensity score\u2010adjusted HR estimates indicated that surgical best practices accounted for 54% of the numerical OS difference between low\u2010volume and high\u2010volume centers. Each surgical best practice was independently associated with improved OS (all <jats:italic>P<\/jats:italic>\u00a0\u2264\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Quantifiable and potentially modifiable surgical best practices largely account for resected early\u2010stage NSCLC outcome differences observed between low\u2010 and high\u2010volume centers. Adherence to these guidelines may reduce and potentially eliminate these differences.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.3055","type":"journal-article","created":{"date-parts":[[2020,4,22]],"date-time":"2020-04-22T02:25:19Z","timestamp":1587522319000},"page":"4137-4147","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Closing the gap: Contribution of surgical best practices to outcome differences between high\u2010 and low\u2010volume centers for lung cancer resection"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0530-3169","authenticated-orcid":false,"given":"Mitchell S.","family":"von Itzstein","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong","family":"Lu","sequence":"additional","affiliation":[{"name":"Quantitative Biomedical Research Center University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kemp H.","family":"Kernstine","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan A.","family":"Halm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA"},{"name":"Department of Population and Data Sciences University of Texas Southwestern Medical Center Dallas TX USA"},{"name":"Harold C. Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shidan","family":"Wang","sequence":"additional","affiliation":[{"name":"Quantitative Biomedical Research Center University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Xie","sequence":"additional","affiliation":[{"name":"Quantitative Biomedical Research Center University of Texas Southwestern Medical Center Dallas TX USA"},{"name":"Harold C. Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David E.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA"},{"name":"Department of Population and Data Sciences University of Texas Southwestern Medical Center Dallas TX USA"},{"name":"Harold C. Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,4,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0025-9"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.07.027"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000252402.33814.dd"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200107193450306"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.07.007"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2016.06.007"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-137-6-200209170-00012"},{"issue":"3","key":"e_1_2_10_9_1","first-page":"518","article-title":"Locoregional recurrence after segmentectomy for clinical\u2010T1aN0M0 radiologically solid non\u2010small\u2010cell lung carcinoma","volume":"51","author":"Hattori A","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.04.033"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008356"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.04.034"},{"issue":"3","key":"e_1_2_10_13_1","first-page":"511","article-title":"The importance of lymph node dissection accompanying wedge resection for clinical stage IA lung cancer","volume":"51","author":"Stiles BM","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.6905"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-007-9747-3"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/qims.2018.08.02"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.18158"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"e_1_2_10_19_1","unstructured":"Cancer Co. 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