Current status of surgery for clinical stage IA lung cancer in Japan: analysis of the national clinical database

Norihiko Ikeda,Masami Sato,Takashi Kondo,Masayuki Chida,Eriko Fukuchi,Kohei Yokoi,Hiroaki Miyata,Hiroyasu Yokomise,Meinoshin Okumura,Jun Nakajima,Akinori Iwasaki,Shunsuke Endo,Hiroshi Date,Hiroyuki Yamamoto

doi:10.1007/s00595-020-02063-x

Abstract

PurposeAs the number of cases of early lung cancer in Japan grows, an analysis of the present status of surgical treatments for clinical stage IA lung cancer using a nationwide database with web-based data entry is warranted.MethodsThe operative and perioperative data from 47,921 patients who underwent surgery for clinical stage IA lung cancer in 2014 and 2015 were obtained from the National Clinical Database (NCD) of Japan. Clinicopathological characteristics, surgical procedure, mortality, and morbidity were analyzed, and thoracotomy and video-assisted thoracic surgery (VATS) were compared.ResultsThe patients comprised 27,208 men (56.8%) and 20,713 women (43.2%); mean age, 69.3 years. Lobectomy was performed in 64.8%, segmentectomy in 15.2%, and wedge resection in 19.8%. The surgical procedures were thoracotomy in 12,194 patients (25.4%) and a minimally invasive approach (MIA) in 35,727 patients (74.6%). MIA was divided into VATS + mini-thoracotomy (n = 13,422, 28.0%) and complete VATS (n = 22,305, 46.5%). The overall postoperative mortality rate was 0.4%, being significantly lower in the MIA group than in the thoracotomy group (0.3% vs 0.8%, P < 0.001).ConclusionsOur analysis of data from the NCD indicates that MIA has become the new standard treatment for clinical stage IA lung cancer.

Highlights

Lung cancer is the leading cause of cancer-related deaths across the world
The number of early lung cancers being diagnosed is increasing with the widespread use of chest computed tomography (CT)
An analysis of the current status of surgical treatments for stage IA lung cancer based on the National Clinical Database (NCD) data will be highly beneficial

Summary

Introduction

Lung cancer is the leading cause of cancer-related deaths across the world. The 5-year survival rate of stage IA lung cancer patients is 86.8% [1]; curative treatment in the early stage is indicative of a favorable prognosis. Videoassisted thoracic surgery (VATS) is used widely for the treatment of stage IA lung cancer. In Japan, 28,568 lung cancer operations were performed using VATS in 2016, accounting for 67.8% of the total operations (n = 42,107) [2]. An assessment of the surgical treatments for stage I lung cancer.

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Results

Conclusion