title: Characteristics associated with the use of nonanatomic resections among Medicare patients undergoing resections of early-stage lung cancer.
abstract: BACKGROUND
  Racial disparities in access to surgical resection for treatment of early-stage non-small-cell lung cancer (NSCLC) are well documented. However it is unclear how race, clinical, and hospital characteristics affect the surgical approach among patients undergoing resection.
  
  
  METHODS
  Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)/Medicare linked database, we identified patients 67 years of age or older diagnosed with stage I NSCLC who underwent surgical resection from 2000 to 2007. Surgical approach was categorized as lobectomy or segmentectomy (anatomic) versus wedge resection (nonanatomic). We used logistic regression to identify the association between demographic, clinical, and hospital factors and the use of nonanatomic resections.
  
  
  RESULTS
  There were 8,986 patients in the sample (mean age, 75 years; 53% women); 12.8% underwent nonanatomic resection. The use of nonanatomic resection increased significantly, from 11.0% in 2000 to 15.9% in 2007 (p=0.008). In multivariable analysis, race was not associated with the receipt of nonanatomic resection. Factors associated with the use of nonanatomic resections included age greater than 80 years (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.15-1.98), T1a primary tumor status, chronic obstructive pulmonary disease (COPD) (OR, 1.81; 95% CI, 1.55-2.12), and volume of hospital lung resections performed (highest versus lowest hospital volume, OR, 1.58; 95% CI, 1.23-2.04). More nonanatomic resections were performed in 2007 than in 2000 (OR, 1.73; 95% CI, 1.27-2.37). After stratifying by tumor size, the temporal trend in the use of nonanatomic resection remained significant only among patients with tumors greater than 3 cm.
  
  
  CONCLUSIONS
  Since 2000, the use of nonanatomic resections in stage I NSCLC has increased, most significantly among patients with larger tumors. After adjusting for clinical factors, there was no relation between race and type of surgical resection.
authors: Section of Thoracic Surgery, Department of Therapeutic Radiology and Radiation Oncology, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, Connecticut 06520, USA. anthony.kim@yale.edu
authors: Anthony W
authors: AW
authors: Kim
authors: Frank C
authors: FC
authors: Detterbeck
authors: Daniel J
authors: DJ
authors: Boffa
authors: Roy H
authors: RH
authors: Decker
authors: Pamela R
authors: PR
authors: Soulos
authors: Laura D
authors: LD
authors: Cramer
authors: Cary P
authors: CP
authors: Gross
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005006:Ethnicity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000033:anatomy & histology / Q000601:surgery; D008175:Lung Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States