Elsevier

Lung Cancer

Volume 46, Issue 2, November 2004, Pages 227-232
Lung Cancer

The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer

https://doi.org/10.1016/j.lungcan.2004.03.010Get rights and content

Abstract

We aimed to evaluate the effect of the appointment of a dedicated specialist thoracic surgeon on surgical practice for lung cancer previously served by cardio-thoracic surgeons. Outcomes were compared for the 240 patients undergoing surgical resection for lung cancer in two distinct 3-year periods: Group A: 65 patients, 1994–1996 (pre-specialist); Group B: 175 patients, 1997–1999 (post-specialist). The changes implemented resulted in a significant increase in resection rate (from 12.2 to 23.4%, P<0.001), operations in the elderly (over 75 years) and extended resections. There were no significant differences in stage distribution, in-hospital mortality or stage-specific survival after surgery. Lung cancer surgery provided by specialists within a multidisciplinary team resulted in increased surgical resection rates without compromising outcome. Our results strengthen the case for disease-specific specialists in the treatment of 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)

  • Berrino R, Capocaccia R, Esteve J, Gatta G, Hakulinen T, Micheli A, Sant M, Verdecchia A. Survival of cancer patients...
  • Joslin CF, Rider L. Yorkshire Regional Cancer Organisation. Cancer in Yorkshire. Cancer Registry Special Report Series...
  • J.S. Brown et al.

    Age and the treatment of lung cancer

    Thorax

    (1996)
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