TY - JOUR
T1 - Definition and assessment of high risk in patients considered for lobectomy for stage I non–small cell lung cancer
T2 - The American Association for Thoracic Surgery expert panel consensus document
AU - The AATS Clinical Practice Standards Committee: Thoracic Surgery
AU - Pennathur, Arjun
AU - Brunelli, Alessandro
AU - Criner, Gerard J.
AU - Keshavarz, Homa
AU - Mazzone, Peter
AU - Walsh, Garrett
AU - Luketich, James
AU - Liptay, Michael
AU - Wafford, Q. Eileen
AU - Murthy, Sudish
AU - Marshall, M. Blair
AU - Tong, Betty
AU - Lanuti, Michael
AU - Wolf, Andrea
AU - Pettiford, Brian
AU - Loo, Billy W.
AU - Merritt, Robert E.
AU - Rocco, Gaetano
AU - Schuchert, Matthew
AU - Varghese, Thomas K.
AU - Swanson, Scott J.
N1 - Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Objective: Lobectomy is a standard treatment for stage I non–small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. Results: The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. Conclusions: Defining who is at high risk for lobectomy for stage I non–small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.
AB - Objective: Lobectomy is a standard treatment for stage I non–small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. Results: The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. Conclusions: Defining who is at high risk for lobectomy for stage I non–small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.
KW - lobectomy
KW - risk assessment
KW - stage I non–small cell lung cancer
UR - http://www.scopus.com/inward/record.url?scp=85118282740&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118282740&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2021.07.030
DO - 10.1016/j.jtcvs.2021.07.030
M3 - Article
C2 - 34716030
AN - SCOPUS:85118282740
SN - 0022-5223
VL - 162
SP - 1605-1618.e6
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -