Quality in Lung Cancer Surgery: A Structure-Process-Outcome Perspective

Lung cancer surgery has evolved substantially, but safety alone does not define quality. Using the Avedis Donabedian model, quality encompasses structure, process, and outcomes. Structural factors include surgeon specialization, institutional volume, and multidisciplinary care. Process indicators involve guideline-concordant staging, systematic lymphadenectomy, and complete resection; inadequate nodal assessment or uncertain resection negatively affects survival. Outcomes extend beyond mortality to oncologic results and patient-centered measures. Composite metrics such as textbook outcome and failure-to-rescue support benchmarking, while society-driven databases enable risk-adjusted comparisons. Current frameworks emphasize perioperative and technical metrics, but underrepresent patient-reported outcomes, long-term survival, and multimodality care.