Resection rate and outcome of pulmonary resections for non-small-cell lung cancer: a nationwide study from Iceland.

• Published in: Journal of Thoracic Oncology
• Main Authors: Thorsteinsson, Hunbogi, Alexandersson, Asgeir, Oskarsdottir, Gudrun N, Skuladottir, Rut, Isaksson, Helgi J, Jonsson, Steinn, Gudbjartsson, Tomas
• Other Authors: Faculty of Medicine, and †Department of Cardiothoracic Surgery, University of Iceland, Reykjavik, Iceland.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Lippincott Williams & Wilkins 2013
• Subjects: Adenocarcinoma; Adult; Aged; 80 and over; Carcinoma; Non-Small-Cell Lung; Squamous Cell; Female; Follow-Up Studies; Humans; Iceland; Lung Neoplasms; Male; Medical Records; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Pneumonectomy; Postoperative Complications; Prognosis; Retrospective Studies; Survival Rate
• Online Access: http://hdl.handle.net/2336/301916; https://doi.org/10.1097/JTO.0b013e318252d022

The proportion of patients with non-small-cell lung cancer (NSCLC) who undergo surgery with curative intent is one measure of effectiveness in treating lung cancer. To the best of our knowledge, surgical resection rate (SRR) for a whole nation has never been reported before. We studied the SRR and surgical outcome of NSCLC patients in Iceland during a recent 15-year period. This was a retrospective study of all pulmonary resections performed with curative intent for NSCLC in Iceland from 1994 to 2008. Information was retrieved from medical records and from the Icelandic Cancer Registry. Patient demographics, postoperative tumor, node, metastasis stage, overall survival, and complication rates were compared over three 5-year periods. Of 1530 confirmed cases of NSCLC, 404 were resected, giving an SRR of 26.4%, which did not change significantly during the study period. Minor and major complication rates were 37.4% and 8.7%, respectively. Operative mortality rates were 0.7% for lobectomy, 3.3% for pneumonectomy, and 0% for lesser resection. Five-year survival after all procedures was 40.7% and improved from the first to the last 5-year period (34.8% versus 43.8%, p = 0.04). Five-year survival for stages I and II together was 46.8%, with no significant change in stage distribution between periods. Five-year survival after pneumonectomy was 22.0%, which was significantly lower than for lobectomy (44.6%) and lesser resection (40.7%) (p < 0.005). Unoperated patients had a 5-year survival of 4.8%, as compared to 12.4% for all the NSCLC patients together. Compared with most other published studies, the SRR of NSCLC in Iceland is high. Short-term outcome is good, with a low rate of major complications and an operative mortality of only 1.0%. Five-year survival improved significantly over the study period.