Surgical resection and long‐term survival outcome for non‐small cell lung cancer: A comparison of V ictorian population‐based studies spanning a decade

• Published in: Asia-Pacific journal of clinical oncology Vol. 10; no. 1; pp. 75 - 79
• Main Authors: Wright, Gavin M, Thursfield, Vicky J, Ball, David L, Richardson, Gary E, Irving, Louis, Giles, Graham G, Mitchell, Paul
• Format: Journal Article
• Language: English
• Published: 01.03.2014
• ISSN: 1743-7555; 1743-7563
• DOI: 10.1111/ajco.12158

Abstract Aim A survey of management of lung cancer diagnosed in V ictoria in 2003 was commissioned by the V ictorian C ooperative O ncology G roup to identify gaps in the management of this disease. Results from a similar survey in 1993 were available to identify differences in the disease, management and outcomes. This paper details results of the surgically managed subset within the larger study. Methods All patients diagnosed with lung cancer in the first 6 months of 2003 were identified from the V ictorian C ancer R egistry. Registry research staff completed a detailed questionnaire using primary source documents from hospitals and consulting rooms. The survey data were then de‐identified with respect to patient and treating clinician prior to statistical analysis by the investigators. Results From eligible cases identified, non‐small cell lung cancer was confirmed in 655 cases with a minimum of 6 years of follow‐up. Thoracotomy was performed in 145 cases (22%), but only 130 received the intended resection. Compared with 1993, significant differences were increased use of preoperative positron emission tomography ( PET ) scanning (79% vs 0%), relatively fewer resections (20% vs 25%), lower pneumonectomy rate (14% vs 25%) and higher sub‐lobar resection rate (22% vs 11%). The 30‐day mortality remained below 2%. Positive resection margin (21%) and abandoned resection rates (10%) were much higher than expected. Overall 5‐year survival was 42%, unchanged from 1993. Conclusion Irrespective of widespread introduction of PET scanning, thoracotomy without resection was common. While operative mortality and overall survival were well within benchmark standards, futile thoracotomy and positive resection margin rates were unacceptably high.