The impact of surgeon experience on lung cancer operations: A retrospective propensity-matched cohort study

To compare the clinical and oncological results of anatomical resection of primary non-small cell lung cancers performed by resident and specialist surgeons as the lead surgeon in a medium-volume, mixed-practice hospital.

We retrospectively collected individual patient record data. Between 1 January 2000 and 31 December 2020, a total of 959 primary lung cancer cases underwent intention-to-treat surgical resection at the Oulu University Hospital. Of these surgeries, 108 were performed by a resident surgeon as the lead surgeon. Propensity score matching was used to find similar unique resident-led cases to compare with unique specialist-led cases in a 1:2 ratio.

After propensity score matching, 65 resident-led cases were eligible for comparison to 130 specialist-led cases. Intra-operative complications were similar in both groups; resident-led cases had a complication rate of 12.3%, whereas specialist-led cases had a complication rate of 8.5% (p = 0.445). The incidence of major Clavien-Dindo complications (>IIIa) was 12.3% and 15.4% (p = 0.668), respectively. In the Kaplan-Meier analysis, the overall survival rate at 1, 3, and 5 years was 90.0%, 71.3%, and 65.3%, respectively, in resident-led cases and 88.2%, 66.6%, and 54.5%, respectively, in specialist-led cases (p = 0.389). Disease-specific survival at 1, 3, and 5 years was 90.0%, 77.6%, and 71.1%, respectively, in resident-led cases and 91.4%, 76.3%, and 76.3%, respectively, in specialist-led cases (p = 0.931).

There was no difference in intra- and post-operative complication rate based on surgeon expertise. Both short-term and long-term results were comparable between resident- and specialist-led surgeries.