MedicalResearch.com Interview with:
Carlos E. Bravo Iñiguez, M.D.
Clinical Research Fellow in Thoracic Oncology
Brigham and Women´s Hospital (BWH)/Harvard Medical School (HMS)
Department of Surgery, Division of Thoracic Surgery
Center for Surgery and Public Health
Boston, MA, 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Bravo: The National Lung Screening Trial (NLST) determined the ability of low-dose computed tomography (LDCT) scans to reduce Lung Cancer specific mortality by 20% in high-risk patients. This reduction was partly dependent on the low surgical mortality experienced at the major academic centers, centers that were pioneers in minimally invasive lobectomy techniques.
In December 2013, The United States Preventive services task force (USPTF) endorsed annual low-dose computed tomography screening for Americans between ages 55 to 80 years who have 30 pack-years of smoking history and have smoked within 15 years.
On April 30th, 2014 the Centers for Medicare and Medicaid Services expressed concerns and raised skepticism as to whether the benefit of implementing a Lung Cancer Screening Program for the Medicare population could be maintained nationwide. Specifically, they doubted low mortality and morbidity rates achieved by the NLST in the elderly patients could be maintained throughout the United States and across a broad range of hospital settings.
Medical Research: What are the main findings?
Dr. Bravo: Mortality after lung resection has been decreasing over the past five decades. We analyzed a nationally validated database intended to measure and improve quality of surgical care – The American College of Surgeons National Surgical Quality improvement Program (ACS-NSQIP)- in order to find this answer.
The Overall Mortality rate was 2.34%. This included academic and community hospitals. Further analysis showed a significant difference on this rate depending on surgical technique: 3.13% for those undergoing Open thoracotomy lobectomy and 1.19% for those who underwent minimally invasive video-assisted Thoracoscopic lobectomy. Morbidity rate was 19.9% consistent with other recent prospective clinical trials.
Medical Research: What should clinicians and patients take away from your report?
Dr. Bravo: These results showed that current operative mortality is not limited to pioneering centers in minimally invasive surgery or large academic centers but has now pervaded centers participating in the ACS-NSQIP database. Briefly, 8% of US hospitals providing adult care participate in the database. They include a mixture of academic centers and community hospitals with 29% of participants defined as non teaching hospitals and 31% having fewer than 500 licensed beds.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Bravo: Prospective data collection in the context of the recently implemented lung cancer screening program will be necessary to further refine screening criteria and implementation strategies. Also, results of ongoing randomized trials on sublobar resections for Lung cancer can favorably impact the results of the screening program reducing even more the morbidity and mortality.
Thirty-Day Mortality After Lobectomy in Elderly Patients Eligible for Lung Cancer Screening
Carlos E. Bravo Iñiguez, M.D. (2015). Mortality After Lung Cancer Resection Steadily Decreasing