{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T19:22:10Z","timestamp":1768850530717,"version":"3.49.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To evaluate the impact of a quality improvement initiative on intraoperative lymph node (LN) dissection adequacy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A single-centre cohort of 781 na\u00efve patients who underwent resection of non-small cell lung cancer with pathological LN involvement and survived beyond 90\u2009days was reviewed. LN dissection metrics were compared before and after the implementation of a quality improvement initiative. Quality metrics (QM) were: QM1 (\u226510 LN examined), QM2 (\u22653 intrapulmonary and hilar LN, \u2265 3 mediastinal stations, including station 7 in all cases), and QM3 (combination of QM1 and QM2).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The proportion of patients meeting QM1 did not differ significantly between the pre- (87.8%) and post-implementation (89.1%) periods. However, meeting QM2 and QM3 significantly improved from 79.5% to 88.6% (P\u2009=\u20090.001), and 76.2% to 84.4% (P\u2009=\u20090.007), respectively. Cox proportional hazard regression model for disease-free survival showed that patients operated on after the implementation of the quality improvement initiative exhibited better disease-free survival compared to those operated on before [adjusted hazard ratio (aHR): 0.73; 95% confidence interval (CI) 0.59\u20130.90; P\u2009=\u20090.003]. Nevertheless, none of these quality metrics influenced long-term outcomes. In contrast, adjuvant chemotherapy (aHR: 0.55; 95% CI 0.43\u20130.71; P\u2009&amp;lt;\u20090.001) was associated with improved disease-free survival. In case of metastatic progression, immunotherapy improved overall survival (hazard ratio: 0.54; 95% CI 0.37\u20130.77; P\u2009=\u20090.0003).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Utilizing transparent data and collaborative feedback were effective to enhance the quality of nodal assessment in lung cancer surgery. Overall, long-term outcomes for patients with lymph node involvement was primarily associated with disease burden, adjuvant chemotherapy, and rescue immunotherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>IRB approval number<\/jats:title>\n                  <jats:p>CERC-SFCTCV-2024-04-30_34750 on 30 April 2024.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae438","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T01:36:57Z","timestamp":1734053817000},"source":"Crossref","is-referenced-by-count":2,"title":["A pilot quality improvement initiative for lymph node dissection during lung cancer surgery"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3305-6989","authenticated-orcid":false,"given":"Pascal Alexandre","family":"Thomas","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesare","family":"Braggio","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-3899","authenticated-orcid":false,"given":"Alex","family":"Fourdrain","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthieu","family":"Vasse","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"Brioude","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delphine","family":"Trousse","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Boulate","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Philippe","family":"Dales","sequence":"additional","affiliation":[{"name":"Department of Pathology, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Doddoli","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascale","family":"Tomasini","sequence":"additional","affiliation":[{"name":"Multidisciplinary Oncology and Therapeutic Innovations Department, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier Beno\u00eet","family":"D\u2019journo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Diseases of the Esophagus and Lung Transplantation, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurent","family":"Greillier","sequence":"additional","affiliation":[{"name":"Multidisciplinary Oncology and Therapeutic Innovations Department, Assistance Publique-H\u00f4pitaux de Marseille and Aix-Marseille University, H\u00f4pital Nord , Marseille,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"2024121301382233800_ezae438-B1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1001\/jamaoncol.2017.2993","article-title":"Association of pathologic nodal staging quality with survival among patients with non-small cell lung cancer after resection with curative intent","volume":"4","author":"Smeltzer","year":"2018","journal-title":"JAMA Oncol"},{"key":"2024121301382233800_ezae438-B2","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ejcts.2006.08.008","article-title":"ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer","volume":"30","author":"Lardinois","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024121301382233800_ezae438-B3","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S1470-2045(18)30768-X","article-title":"Intraoperative lymph-node assessment during NSCLC surgery: the need for standardisation and quality evaluation","volume":"20","author":"Thomas","year":"2019","journal-title":"Lancet Oncol"},{"key":"2024121301382233800_ezae438-B4","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.jtho.2022.08.009","article-title":"Assessment of updated commission on cancer guidelines for intraoperative lymph node sampling in early stage NSCLC","volume":"17","author":"Heiden","year":"2022","journal-title":"J Thorac Oncol"},{"key":"2024121301382233800_ezae438-B5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.lungcan.2005.01.001","article-title":"Complete resection in lung cancer surgery: proposed definition","volume":"49","author":"Rami-Porta","year":"2005","journal-title":"Lung Cancer"},{"key":"2024121301382233800_ezae438-B6","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jtho.2019.10.019","article-title":"International association for the study of lung cancer staging and prognostic factors committee, advisory board members, and participating institutions. The IASLC lung cancer staging project: analysis of resection margin status and proposals for residual tumor descriptors for non-small cell lung cancer","volume":"15","author":"Edwards","year":"2020","journal-title":"J Thorac Oncol"},{"key":"2024121301382233800_ezae438-B7","doi-asserted-by":"crossref","first-page":"102126","DOI":"10.1016\/j.respe.2023.102126","article-title":"Regulation of medical research in France: striking the balance between requirements and complexity","volume":"71","author":"Boyer","year":"2023","journal-title":"Rev Epidemiol Sante Publique"},{"key":"2024121301382233800_ezae438-B8","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The strengthening the reporting of observational studies in epidemiology (strobe) statement: guidelines for reporting observational studies","volume":"12","author":"Von Elm","year":"2014","journal-title":"Int J Surg"},{"key":"2024121301382233800_ezae438-B9","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/JTO.0b013e3181a0d82e","article-title":"The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer","volume":"4","author":"Rusch","year":"2009","journal-title":"J Thorac Oncol"},{"key":"2024121301382233800_ezae438-B10","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jtho.2015.09.009","article-title":"The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer","volume":"11","author":"Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"key":"2024121301382233800_ezae438-B11","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1378\/chest.10-0859","article-title":"Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial","volume":"139","author":"Darling","year":"2011","journal-title":"Chest"},{"key":"2024121301382233800_ezae438-B12","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.athoracsur.2014.03.023","article-title":"Number of mediastinal lymph nodes in non-small cell lung cancer: a Gaussian curve, not a prognostic factor","volume":"98","author":"Riquet","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2024121301382233800_ezae438-B13","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/BF01627676","article-title":"Anatomic basis of lymphatic spread of lung carcinoma to the mediastinum: anatomo-clinical correlations","volume":"16","author":"Riquet","year":"1994","journal-title":"Surg Radiol Anat"},{"key":"2024121301382233800_ezae438-B14","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.jtho.2017.07.027","article-title":"Adequacy of intraoperative nodal staging during surgical resection of NSCLC: influencing factors and its relationship to survival","volume":"12","author":"Edwards","year":"2017","journal-title":"J Thorac Oncol"},{"key":"2024121301382233800_ezae438-B15","doi-asserted-by":"crossref","first-page":"4902","DOI":"10.21037\/jtd.2018.07.23","article-title":"Assessment of adequacy of intraoperative nodal staging and factors influencing the lack of its compliance with recommendations in the surgical treatment of non-small cell lung cancer (NSCLC)","volume":"10","author":"Pawelczyk","year":"2018","journal-title":"J Thorac Dis"},{"key":"2024121301382233800_ezae438-B16","doi-asserted-by":"crossref","first-page":"ezae251","DOI":"10.1093\/ejcts\/ezae251","article-title":"EPITHOR working group. Real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage c-IA lung carcinoma","volume":"66","author":"Thomas","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024121301382233800_ezae438-B17","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1016\/j.jtho.2021.06.027","article-title":"Trends in Accuracy and Comprehensiveness of Pathology Reports for Resected NSCLC in a High Mortality Area of the United States","volume":"16","author":"Smeltzer","year":"2021","journal-title":"J Thorac Oncol"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/66\/6\/ezae438\/61099642\/ezae438.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/66\/6\/ezae438\/61099642\/ezae438.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T01:38:31Z","timestamp":1734053911000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezae438\/7914931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,28]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,11,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezae438","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,12]]},"published":{"date-parts":[[2024,11,28]]},"article-number":"ezae438"}}