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Introduction: Compliance with the Commission on Cancer (CoC) Operative Standard 5.8 Pulmonary Resection results in longer patient survival and better surgical outcomes. The CoC operative standard calls for all curative intent lung cancer resections to have at least 3 mediastinal lymph node stations in addition to at least 1 hilar station sampled at the time of resection at a minimum rate of 80%. Our project aim was to meet or exceed this standard by having all practicing thoracic surgeons at Henry Ford Hospital routinely achieve a minimum of 3+1 nodal station sampling on 80% of all primary lung cancer resections for pneumonectomy, lobectomy, segmentectomy and wedge. Anatomic pulmonary resection, achieving an R0 margin, and compliance with CoC 5.8 has been shown to improve survival in surgical patients by 14% for non small cell lung cancer. Methods: A retrospective analysis of prospectively collected data on all therapeutic resections for lung cancer at a single institution between 2021-2023 were reviewed. An intraoperative process change was implemented for all surgeons to follow whereby a “time out” occurs prior to case completion. The circulating nurse reads back all nodal stations sampled. If 3+1 sampling is not achieved, the surgeon reexamines nodal stations prior to case closure. Surgical cases are abstracted and entered in the data base approximately 45 days after surgery. Compliance rates per surgeon are communicated by the Database Manager directly to the Surgeon Champion and subsequently communicated to the primary surgeons. This was done continuously over the focus period leading to increased compliance with Standard 5.8. Results: 2021 data revealed baseline compliance of 69.5% with Standard 5.8. This increased to 79.2% in 2022 and an 85.2% compliance rate in 2023. Conclusions: A concerted effort by the surgical team to implement a staged “time out” prior to conclusion of surgical cases resulted in increased compliance with the CoC Standard 5.8 at our institution.

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Henry Ford Health


Detroit, Michigan


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Project #33: Achieving Commission on Cancer Operative Standard 5.8 for Primary Lung Cancer Resections



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