The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer
Introduction
Non-small-cell lung cancer (NSCLC) in the United Kingdom currently affects 40,000 patients per annum [1]. The management of NSCLC has been sub-optimal compared with other European countries and the USA [2], [3], [4], [5]. Reasons behind this may include lack of specialist expertise or nihilism towards the disease in the UK leading to patients either not being investigated or offered radical treatment, particularly in the elderly [6], [7], [8]. Some of the reasons explaining the limited success in effective management of lung cancer were addressed in the British government’s document on Commissioning Cancer Services [9]. An important issue was the fact that clinicians who are not disease-specific specialists treated many cases. Reports have shown the benefits of specialist care in outcomes after surgery for NSCLC, with special emphasis on elderly and high-risk groups [10].
We aimed to assess the impact of a change of surgical practice in a single health authority consequent on the new appointment of a specialist thoracic surgeon by comparing the practices in two consecutive 3-year periods immediately before and after the appointment.
Section snippets
Patients
All the patients resident within a single health authority and diagnosed with NSCLC during the 6-year period were included in this study. Other patients operated in our hospital during the same time period who were resident in different counties are not included in this study. The patients were identified by several different means to maximize recruitment: Regional Cancer Registry, Hospital Code Databases and Surgical Databases. The medical case notes were retrospectively reviewed in all
Diagnosis
Over the 6-year period, from January 1994 to December 1999, 2891 patients resident in Leicestershire were recorded with lung cancer. There was no significant change in annual incidence (Table 1). However, histological confirmation of non-small-cell lung cancer (NSCLC) was obtained in a significantly larger proportion of patients from Group B (51%) than from Group A (37%) (P<0.001).
Resection rate
Sixty-five patients underwent surgical resection between 1994 and 1996, while 175 did so during 1997–1999. The
Discussion
Surgery provides the most reliable treatment for patients with early-stage NSCLC [11]. However, recent studies have consistently demonstrated lower resection rates in the UK than in the US [2] or other European countries [3], [4], [5], and according to the Thoracic Surgical Registry returns of the Society of Cardio-Thoracic Surgeons of Great Britain and Ireland, very little had changed during the 1990s [13]. The resection rate in the UK has been traditionally estimated around 10% [1], although
Conclusion
In summary, the appointment of a thoracic surgical specialist within a multidisciplinary team has resulted in almost a three-fold increase in the absolute numbers of patients undergoing surgical resection. These changes occurred without increased surgical mortality, significant change in stage distribution or decreased survival.
Our results have implications for the national practice in the UK. At the present in the United Kingdom, 60% of the thoracic surgical practice is performed by
References (27)
- et al.
Variation in survival of patients with lung cancer in Europe
Eur J Cancer
(1998) - et al.
Specialists achieve better outcomes than generalists for lung cancer surgery
Chest
(1998) - et al.
Prognostic factors in non-small cell lung cancer
Chest
(2002) Revisions in the International System for Staging Lung Cancer
Chest
(1997)- et al.
Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer
Ann Thorac Surg
(2000) - et al.
Conditional survival among patients with carcinoma of the lung
Chest
(1999) - et al.
The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer
Surgery
(2002) - Joint Working Group of The British Thoracic Society and The Society of Cardiothoracic Surgeons of Great Britain and...
- et al.
Resection rates and postoperative mortality in 7899 patients with lung cancer
Eur Respir J
(1996) - et al.
The National Cancer Data Base report on lung cancer
Cancer
(1996)
Age and the treatment of lung cancer
Thorax
Cited by (73)
Does Multidisciplinary Team Management Improve Clinical Outcomes in NSCLC? A Systematic Review With Meta-Analysis
2023, JTO Clinical and Research ReportsOutcomes of Anatomic Lung Resection for Cancer Are Better When Performed by Cardiothoracic Surgeons
2021, Annals of Thoracic SurgeryHospital lung surgery volume and patient outcomes
2019, Lung CancerCitation Excerpt :We observed that 22% of patients underwent resection for NSCLC, similar to data from an earlier Victorian study as well as data from New South Wales (NSW) and Queensland where surgical rates are between 17–20% [2,10–12]. We are comparable to overseas centres in the United Kingdom (UK) and Europe although our data describe a more recent cohort [13–15]. Our data demonstrated that 57%, 38% and 5% of patients with NSCLC underwent a lobectomy, sub-lobar resection and pneumonectomy respectively, compared to 63%, 32% and 5% in NSW.
Organization of lung cancer care
2018, Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and ManagementTransatlantic editorial: Thoracic surgeons need recognition of competence in thoracic oncology
2017, Journal of Thoracic and Cardiovascular SurgeryTransatlantic Editorial: Thoracic Surgeons Need Recognition of Competence in Thoracic Oncology
2017, Annals of Thoracic Surgery