Underlying Reasons for Failure to Achieve Adequate Lymph Node Staging During Lung Cancer Resection: Results of a Clinical Failure Modes Effects and Criticality Analysis
Presented During:
Monday, May 8, 2023: 3:39PM - 3:42PM
Los Angeles Convention Center
Posted Room Name:
Exhibit Hall
Abstract No:
P0148
Submission Type:
Abstract Submission
Authors:
David Odell (1), Charles Logan (2), Lixuan Cong (3), Ryan Jacobs (1), Cassie Valukas (4), Samuel Kim (5), Diego Avella (1), Kalvin Lung (1), Anjana Yeldandi (3), Ankit Bharat (1)
Institutions:
(1) Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, (2) Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, United States, (3) Northwestern University, Chicago, IL, (4) Northwestern Unversity, Chicago, IL, (5) Canning Thoracic Institute, Northwestern University Feinberg School of Medicine, Chicago
Submitting Author:
David Odell
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Co-Author(s):
Charles Logan
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Lixuan Cong
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Northwestern University
Northwestern University
Ryan Jacobs
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Cassie Valukas
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Northwestern Unversity
Northwestern Unversity
♦Samuel Kim
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Diego Avella Patino
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Kalvin Lung
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Anjana Yeldandi
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Northwestern University
Northwestern University
Ankit Bharat
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Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Canning Thoracic Institute, Northwestern University Feinberg School of Medicine
Presenting Author:
David Odell
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Abstract:
Objective:
Surgical resection of the primary tumor combined with mediastinal lymph node staging is the standard of care for the treatment of early-stage non-small cell lung cancer (NSCLC). The ACS Commission on Cancer has defined adequate lymph node staging as the sampling of at least 3 N2 stations and 1 N1 station. However, despite national quality standards, operative lymph node staging has consistently been poor when examining national data. This study sought to define underlying reasons for inadequate nodal staging and to determine their relative contribution .
Methods:
We convened a multidisciplinary panel of thoracic surgeons, pathologists, and operating room nurses and scrub technicians from hospitals participating in the Illinois Cancer Collaborative (ILCC) to conduct a Failure Modes Effectiveness and Criticality Analysis (FMECA) assessment of operative lymph node staging. The panel first considered the process of lymph node staging from preoperative planning through surgical care and finally pathological analysis and reporting. Key steps (figure) were identified and categorized as critical (failure to perform the step could not be overcome by other actions) and non-critical. To validate this construct, we then reviewed surgical resections performed at the participating hospitals over the past 6 months to identify patients where staging was inadequate and categorize failure points.
Results:
The panel identified 6 key steps in nodal staging: preoperative planning, node identification, adequate dissection, operative specimen labelling, pathologic dissection, and pathological reporting. Node identification, dissection, and pathological reporting were identified as critical process steps. Chart review of 200 anatomic lung resections yielded 51 cases of inadequate staging (26%). The most common root cause was failure to dissect the node in 47% (n=24) followed by pathologic documentation errors in 25% (n=13) and specimen labelling errors in 18% (n=9).
Conclusion:
This study identified critical technical and non-technical skills factors which contribute to inadequate lymph node staging during lung cancer resection. While a technical failure to dissect the lymph node station was the most common failure point, several areas of the process may result in failure to adequately stage patients. These steps provide actionable targets for quality improvement.
This work is funded by the AATS Foundation Surgical Investigator Award
Surgical resection of the primary tumor combined with mediastinal lymph node staging is the standard of care for the treatment of early-stage non-small cell lung cancer (NSCLC). The ACS Commission on Cancer has defined adequate lymph node staging as the sampling of at least 3 N2 stations and 1 N1 station. However, despite national quality standards, operative lymph node staging has consistently been poor when examining national data. This study sought to define underlying reasons for inadequate nodal staging and to determine their relative contribution .
Methods:
We convened a multidisciplinary panel of thoracic surgeons, pathologists, and operating room nurses and scrub technicians from hospitals participating in the Illinois Cancer Collaborative (ILCC) to conduct a Failure Modes Effectiveness and Criticality Analysis (FMECA) assessment of operative lymph node staging. The panel first considered the process of lymph node staging from preoperative planning through surgical care and finally pathological analysis and reporting. Key steps (figure) were identified and categorized as critical (failure to perform the step could not be overcome by other actions) and non-critical. To validate this construct, we then reviewed surgical resections performed at the participating hospitals over the past 6 months to identify patients where staging was inadequate and categorize failure points.
Results:
The panel identified 6 key steps in nodal staging: preoperative planning, node identification, adequate dissection, operative specimen labelling, pathologic dissection, and pathological reporting. Node identification, dissection, and pathological reporting were identified as critical process steps. Chart review of 200 anatomic lung resections yielded 51 cases of inadequate staging (26%). The most common root cause was failure to dissect the node in 47% (n=24) followed by pathologic documentation errors in 25% (n=13) and specimen labelling errors in 18% (n=9).
Conclusion:
This study identified critical technical and non-technical skills factors which contribute to inadequate lymph node staging during lung cancer resection. While a technical failure to dissect the lymph node station was the most common failure point, several areas of the process may result in failure to adequately stage patients. These steps provide actionable targets for quality improvement.
This work is funded by the AATS Foundation Surgical Investigator Award
Categories:
Safety, Quality, and Teamwork
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