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Institution: Northern Health - Victoria, Australia
Purpose: Sub-optimal nodal staging is common during curative-intent resection of lung cancer. The resection is termed uncertain or R(un) when margins are free of tumour, but the conditions for complete resection are not fulfilled. Inadequate nodal assessment is the commonest reason for resections being classified as R(un). Studies have demonstrated poorer outcomes in patients with R(un) compared to those with R0. Audit of completeness of lung cancer resections at Northern Health would be an important step towards assuring quality service to our patients.
Methodology: We conducted an audit of all patients who have had a curative-intent anatomical lung resection for lung cancer between January 2017 and December 2023 at Northern Health. The operation notes and histopathology reports of included patients were queried for number of mediastinal, hilar and intra-pulmonary nodal stations sampled and other factors that would contribute to a R(un) status.
Results: 60 out of 124 resections assessed were judged to be R(un). Inadequate lymphadenectomy was the cause of the R(un) status in 52 (86.6%). There was no relation between R(un) status and approach, tumour histology or lobe resected. There is however an improvement in rates of R(un) over the period from 70% in 2020-2022 to 16% in 2023.
Conclusion: Rates of inadequate lymphadenopathy are unacceptably high in the institution. Various measures have been employed worldwide to improve lymphadenectomy. Use of a lymph node retrieval chart during the procedure may be an easy, inexpensive method. We intend to trial this and study its outcome in the future.
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Dr Mathew Muir - , Dr Ryan Lowe - , Mr Krisnha Bhagwat - , Mr Bibhusal Thapa -