Abstract
ObjectivesData on national patterns of care for patients with superior sulcus tumors (SST) is currently lacking. We investigated the distribution of surgical care and outcome for patients with SST in the Netherlands. Material and methodsData was retrieved from the Dutch Lung Cancer Audit for Surgery (DLCA-S) for all patients undergoing resection for clinical stage IIB-IV SST from 2012 to 2019. Because DLCA-S is not linked to survival data, survival for a separate cohort (2015–2017) was obtained from the Netherlands Cancer Registry (NCR). ResultsIn the study period, 181 patients had SST surgery, representing 1.03% (181/17488) of all lung cancer pulmonary resections. For 2015–2017, the SST resection rate was 14.4% (79/549), and patients with stage IIB/III SST treated with trimodality had a 3-year overall survival of 67.4%. 63.5% of patients were male, and median age was 60 years. Almost 3/4 of tumors were right sided. Surgery was performed in 20 hospitals, with average number of annual resections ranging from ≤ 1 (n = 17) to 9 (n = 1). 39.8% of resections were performed in 1 center and 63.5% in the 3 most active centers. 12.7% of resections were extended (e.g. vertebral resection). 85.1% of resections were complete (R0). Morbidity and 30-day mortality were 51.4% and 3.3% respectively. Despite treating patients with a higher ECOG performance score and more extended resections, the highest volume center had rates of morbidity/mortality, and length of hospital stay that were comparable to those of the medium volume (n = 2) and low-volume centers (n = 1). ConclusionIn the Netherlands, surgery for SST accounts for about 1% of all lung cancer pulmonary resections, the number of SST resections/hospital/year varies widely, with most centers performing an average of ≤ 1/year. Morbidity and mortality are acceptable and survival compares favourably with the literature. Although further centralisation is possible, it is unknown whether this will improve outcomes.
Highlights
Superior sulcus tumors (SST), called Pancoast tumors, account for less than 5% of lung cancers, but they deserve special attention due to their anatomical location in proximity to the spine, large vessels, brachial plexus and other nerves, leading to characteristic pain and neurological deficits, and posing challenges for their resection
To place the numbers of SST patients in the Dutch Lung Cancer Audit for Surgery (DLCA-S) into context of all patients diagnosed with SST, and to provide the reader with survival data with which to assess the quality of SST care, we included data from the Netherlands Cancer Registry (NCR request K19.394), The NCR records basic data on diagnosis, stage, treatment and survival of all cancer patients in the Netherlands
There were 79 patients registered in the DLCA-S as having had a resection for SST, resulting in a resection rate of 14.4%
Summary
Superior sulcus tumors (SST), called Pancoast tumors, account for less than 5% of lung cancers, but they deserve special attention due to their anatomical location in proximity to the spine, large vessels, brachial plexus and other nerves, leading to characteristic pain and neurological deficits, and posing challenges for their resection. There is a long-standing view that complete surgical resection offers the best functional and oncological outcome [1] This is reflected by national and international guidelines recommending trimodality treatment, consist ing of induction chemoradiotherapy (CRT) followed by surgical resec tion, as the preferred treatment for fit patients with a technically resectable SST [2,3,4]. This multimodal regimen offers a high probability of locoregional control after radical (R0) resection, and favorable overall survival in appropriately selected patients [5,6]. Resection may be considered in selected patients with limited mediastinal nodal involvement (N2), and low-volume (oligo-) metastatic disease [9,10]
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