Lung Cancer Resection Rates Research Articles

ES12.01 Defining Operability

ES12.01 Defining Operability

P215 Referral Patterns For Mediastinal Staging With Ebus Across A Lung Cancer Network A Report From The Manchester Cancer Ebus Sub-group

Introduction Manchester Cancer is a large Cancer Network in the North West of England, consisting of ten NHS Trusts. There is known variability in lung cancer outcomes across the ten trusts, including resection rates. We have examined the referral patterns of each individual trust for EBUS mediastinal staging and compared this with the trust’s lung cancer resection rates. Methods The Manchester Cancer EBUS sub-group has data for all EBUS referrals from each of the ten NHS trusts in our Network in 2012. The National Lung Cancer Audit Report 2013 provides the number of lung cancer patients diagnosed at each trust for the same time period. From this data we could estimate the proportion of lung cancer patients from each trust that were referred for mediastinal staging with EBUS. Results In 2012, 2302 patients were diagnosed with lung cancer in this Network. In the same period, 193 patients were referred for EBUS mediastinal staging (8.4%). The proportion of lung cancer patients referred for mediastinal staging with EBUS varied significantly across the ten trusts ranging from 3.4% to 30.2% (p Discussion It is highly concerning that only 8% of lung cancer patients underwent EBUS nodal staging in our network given 52% of UK patients with histologically confirmed NSCLC are stage I-III at the time of diagnosis. It is of note that the Trust with the highest proportion of patients undergoing EBUS nodal staging have the highest surgical resection rate and three of the four Trusts with the lowest resection rates refer

Low Lung Cancer Resection Rates in a Tertiary Level Thoracic Center in Nepal - Where Lies Our Problem?

Resection rates of lung cancer are low in general and especially in countries like Nepal. Advanced stage at presentation and poor general condition of the patient are the usual causes. In this prospective observational study, one hundred cases of lung cancer who presented at the Thoracic Surgery Unit between October 2011 and October 2012 were included. Those aged in the 6th and 7th decades together accounted for 72/100 patients. The male to female ratio was 2:1. There was a mean-29.2±14.2 pack yrs smoking history with only five non-smokers. Seventy-six patients presented with locally advanced disease while 21 had metastases. Only three had local disease. The average time between onset of symptoms to first contact with a doctor was 2.3±5.3 months (range: 0-35.6 months). Average time between first contact to referral was 50.4±65.7 days (range-0-365). Only three patients were resected, one after neo-adjuvant chemotherapy. Advanced disease was the cause of unresectability in 95 cases. One of three patients with local disease had pulmonary functions allowing the warranted resection. N2 disease with T1-3 on CT scan was found in 47. Three of these patients underwent mediastinoscopy and all confirmed uninvolved N2. Lung resection rates in our center remain low. Late presentation leading to advanced disease and poor pulmonary reserves preclude resection in most cases. More liberal use of mediastinal staging and better assessment of pulmonary functions may allow us to improve resection rates.

P61 Factors influencing improved lung cancer resection rates 2006 2012; A single centre case cohort study

BackgroundSurgical resection rates for lung cancer have increased steadily over the last decade. There are a number of possible explanations for this increase which include: earlier presentation, earlier detection and...

The Effects of Increased Provision of Thoracic Surgical Specialists on the Variation in Lung Cancer Resection Rate in England

There is a wide variation in the lung cancer resection rate in England. We assessed the effect of the regional provision of thoracic surgery service on the variation in lung cancer resection rate. A retrospective observational study correlating National Lung Cancer Audit data with thoracic surgery workforce data was performed to review the lung cancer resection rate in England in 2008 and 2009. In 2008, there was a sixfold variation in resection rate, with a higher resection rate in hospitals where surgeons were based (base hospitals) than in peripheral hospitals (20.0% versus 11.6%, p < 0.001). The resection rate was also higher in cancer networks, which were served by two or more specialist thoracic surgeons (14.6% versus 12.7%, p = 0.028), and where surgeons were present in more than two-thirds of the lung cancer multidisciplinary team meetings (14.4% versus 12.0%, p = 0.046). In 2009, the overall resection rate increased from 14.5% to 18.4%. Four units increased their number of specialist thoracic surgeons and had a significantly higher increase in resection rate than units without expansion (relative rise 66.3% versus 19.2%; p = 0.022). The large variation in the resection rate seems, in part, to be related to the local availability of specialist thoracic surgeons. The greatest improvement in the resection rate was in units with expansion of specialist thoracic surgeons. We suggest the expansion of specialist thoracic surgeons will improve the resection rate and thereby the overall survival of lung cancer in England. This has significant implications for the future of training in cardiothoracic surgery and organization of cancer services.

P171 A Retrospective Study of Changing Performance Status and Staging in All Patients Presenting with Lung Cancer to the Northern Health and Social Care Trust Over the Past Decade

Lung cancer resection rates have become more controversial as the publication of the national lung cancer audit has shown such geographical variation and then national improvement over a small number...

Lung cancer resection rates have increased significantly in females during a 15-year period☆

The aim was to carry out a comparative study of lung cancer incidence and resection rates following the introduction of positron emission tomography-computed tomography (PET-CT) and the reorganisation of Cancer Services in Northern Ireland. Data were retrieved from the Regional Thoracic Service Database and Northern Ireland Cancer Registry (NICR) covering the period 1994-2008. The two databases are maintained independently. A total of 13288 lung cancer cases and 1575 lung resections were identified. Secondary tumours were excluded. The incidence of lung tumours and procedures performed was available for each individual year. The incidence of lung cancer was taken from the NICR. The NICR confirmed the diagnosis of lung cancer using international guidelines and cancer was confirmed by histology, cytology, radiological investigations and post-mortem examinations. Poisson regression was used to model the incidence and resections per year; logistic regression was used to model the yearly rate of resections per incidence case. The 15-year period was divided into three periods to assess trends in surgical resection, but the surgical resection rate (SRR) was calculated on a yearly basis. The regional incidence of lung cancer in Northern Ireland (NI) females has increased (1.7% per annum P<0.01, Poisson regression), but this increase has not been seen in males. The incidence of lung cancer patients, who underwent resection at the regional Thoracic Surgery Unit, increased for females (4.4% per annum, P<0.01, Poisson regression), but not for males. The proportional rate of resection (number of resections in a given year/incidence in that year) has changed significantly over the study period for females but not males (the odds ratio per unit year was 1.029, P<0.01, logistic regression). The average age of females increased by 0.2 year (P<0.01) annually; there was no significant increase in the age of males over this period. There was no significant overall rise in the number of patients diagnosed with non-small-cell lung cancer (NSCLC). The percentage of all lung cancer patients who were discussed at multidisciplinary team (MDT) meetings rose from 19% in 1996 to 64% in 2006. The percentage of patients aged over 75 years discussed at an MDT increased from 12% in 1996 to 58% in 2006. The number of females presenting with NSCLC and the number of people presenting with stage I and II disease did not change over the time frame. More patients aged above 70 years had an operation in group III. These accounted for over 50% of the increase in operations between the first and last group. The number of females in this group rose by 92% compared with group I. Significantly, more patients aged over 80 years had an operation in group III than in group I; however, there was significantly more males treated surgically aged over 80 years than females; P=0.001. The resection rate is currently higher in females than males, and has significantly increased during the study period. The incidence in female lung cancer has risen but it is still below male incidence rates. It seems unlikely that one single factor has brought about this increase. With better education among medical practitioners and the public, more lung cancer cases have been considered for surgery by surgeons. There has been an overall increase in patients presented at MDTs involving thoracic surgeons. For whatever reason, it appears that many lung cancer cases in females had previously not been presented to surgeons prior to the introduction of MDT meetings practice guidelines. The development of MDT meetings throughout NI along with the close involvement of the Thoracic Surgical Unit from the inception of all MDTs seems the most likely factor leading to a change in lung cancer resection rates.

Strategies for increasing surgical resection rates in lung cancer

Strategies for increasing surgical resection rates in lung cancer

Lung cancer resection rate in south Manchester: is it comparable to international standards? Results of a prospective tracking study

The UK has been reported to have the lowest resection and survival rates for lung cancer patients. These reports were based largely on retrospective data from the cancer registry and are now outdated. To monitor the present day surgical resection rate at our institution all newly diagnosed cases of lung cancer presenting to us were enrolled into a prospective tracking study. From September 2003 to March 2005 all suspected primary lung cancer referrals to the North West Lung Centre were tracked to identify patients with newly diagnosed lung cancer. The histology of 247 patients confirmed to be new lung cancer cases were small cell (SCLC), non-small cell (NSCLC) and mixed cancers in 33 (16%), 170 (83.5%) and 1 (0.5%) patients, respectively, while 43 patients had no histological confirmation. Overall, 43 patients (17%) underwent surgery while chemotherapy and radiotherapy were used in 91 (38%) and 43 (17%), respectively. Out of 170 confirmed NSCLC patients, 43 (25%), 65 (38%) and 27 (16%) patients underwent surgery, chemotherapy and radiotherapy, respectively. The remaining 35 (20%) did not receive any treatment because of patient wishes or poor condition. The surgical resection rates were 17% for all lung cancers and 25% for NSCLC. Current surgical resection rates at the South Manchester University Hospital are comparable to international standards. Similar data from the rest of the UK are required to determine the national resection rate, which may not be as low as once thought to be.

Is there a role for therapeutic lobectomy for emphysema?☆☆☆

The feasibility of performing a standard lobectomy in patients with non-small cell lung cancer (NSCLC) and severe heterogeneous emphysema whose respiratory reserve is outside standard operability guidelines has been described [Edwards JG, Duthie DJR, Waller DA. Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema. Thorax 2001;56:791-5; Korst RJ, Ginsberg RJ, Ailawadi M, Bains MS, Downey RJ, Rusch V, Stover D. Lobectomy improves ventilatory function in selected patients with severe COPD. Ann Thorac Surg 1998;66:898-902; Carretta A, Zannini P, Puglisi A, Chiesa G, Vanzulli A, Bianchi A, Fumagalli A, Bianco S. Improvement in pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients. Eur J Cardiothorac Surg 1999;15(5):602-7]. Postoperative lung function was better than predicted, attributable to the therapeutic benefit of deflation of the hemithorax. Our aim was to determine whether the physiological benefits of this approach were superior to conventional non-anatomical lung volume reduction surgery (LVRS) in similar patients. A retrospective review of a single surgeon's experience identified 34 consecutive patients who underwent upper lobectomy for completely resected stage I-II NSCLC, and who had severe heterogeneous emphysema of apical distribution with a predicted postoperative FEV1 of less than 40%. Their perioperative characteristics, postoperative spirometry and survival of these cases were compared to 46 similar patients who underwent unilateral upper lobe LVRS during the same period. Data expressed as median (range). LVRS patients were significantly younger (59 years [39-70] vs 67 years [48-79] p<0.001), with more severe airflow obstruction (FEV(1) %pred 24 [12-60] vs 44 [17-54] p<0.001) and more heterogenous disease ('Q' score 4 [0.5-11.5] vs 7 [1-13] p=0.001) than the lobectomy group. No significant difference was found in median survival (88 vs 53 months, p=0.06). Lobectomy patients had a shorter air leak duration (5 days [2-36] vs 9 days [1-40], p=0.02) and hospital stay (8 days [3-63] vs 13 days [6-90] p=0.01). A significant correlation was found between pre-operative Q score and percentage improvement in FEV1 (r=-0.33, p=0.02). Lobectomy for lung cancer in patients in severe heterogenous chronic obstructive pulmonary disease is associated with similar improvement in airflow obstruction as conventional LVRS, but is associated with a shorter postoperative course. Lobectomy may therefore offer a therapeutic alternative to conventional LVRS in a selected population.

Improving the Lung Cancer Resection Rate in the US Department of Veterans Affairs Health System

BackgroundThe optimal treatment for non–small-cell lung cancer (NSCLC) is surgical resection; however, most patients are ineligible because of advanced disease. Although resection rates of 25% have been reported nationally, rates in the Veterans Affairs (VA) system appear lower, perhaps because of limited access to specialized care. We hypothesized that, since the introduction of a specialized Lung Mass Clinic in 1999, the resection rate at the Birmingham VA Medical Center would be comparable with US benchmarks. We also sought to identify the medical and nonmedical factors that influenced the use of surgery. Patients and MethodsWe reviewed the electronic medical records of all veterans seen in the Lung Mass Clinic from 1999 to 2003 and identified patients with NSCLC. Demographics, comorbidities, diagnostic methods, times to diagnosis/resection, and postoperative survival were recorded. Reasons for nonresection were documented and tabulated, and differences between the resected and nonresected subgroups were examined. ResultsOne hundred fifty-six patients with NSCLC were identified, and 31 (20%) underwent resection. There were no differences in age, ethnicity, or sex between those undergoing resection and those denied surgery. Patients who underwent resection were less likely to have chronic obstructive pulmonary disease and had better pulmonary function. Eighty-four percent of those who did not undergo resection had advanced disease, poor pulmonary function, or had refused therapy. Although the median time to resection was longer than expected (104 days), overall survival was comparable with other reports (65% at 3 years). ConclusionSince the inception of the Lung Mass Clinic, the resection rate at Birmingham VA Medical Center has improved. The primary limitation to resection was late presentation and not preoperative delays.

O-181 Developing a strategy to increase lung cancer resection rates

O-181 Developing a strategy to increase lung cancer resection rates

Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema

BACKGROUNDGuidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1 second (ppoFEV1) of <40% as a predictor of high risk. Experience with lung...