Outcomes following pulmonary resections for lung cancer in Iceland - survival in subgroups of patients

• Main Author: Oskarsdottir, Gudrun Nina
• Other Authors: Tómas Guðbjartsson, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2017
• Subjects: Lung cancer surgery; Surgical resection rate; Adenocarcinoma; Lobectomy; Survival; Elderly; Lungnakrabbamein; Skurðlækningar; Lífslíkur; Aldraðir; Doktorsritgerðir; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/283

Lung cancer is the third most common type of cancer and the prime cause of cancer-related deaths in Iceland. As surgical resection is the only well-defined and well-studied curative treatment, the aim is to offer surgery to as many patients as possible who have resectable disease. However, less than one-quarter of the patients (most often non-small cell lung carcinoma, NSCLC) are diagnosed at the early stages and thus are candidates for surgery. The most common surgical procedure is lobectomy, but in some cases a sublobar resection (wedge or segment resection) is performed or pneumonectomy is required. The most common histological type of lung cancer is adenocarcinom (AC), followed by squamous cell carcinoma (SCC) and large cell carcinoma (LCC). The short- and long-term outcomes of pulmonary resections for NSCLC have improved over the past years, and even if the total 5-year survival of lung cancer is less than 20%, the survival of patients with resectable localized disease can be up to 80%. This thesis is based on four peer-reviewed papers (I-IV) and the aim was to investigate four key issues: (1) to investigate the surgical resection rate for lung cancer surgery in a whole nation; (2) to determine short- and long-term outcomes of surgery, with special emphasis on patients who underwent lobectomy, had AC separately, or were elderly (>75 years); (3) to determine whether the international IASLC/ATS/ERS adenocarcinoma classification system from 2011 predicts survival in surgical patients with lung cancer in Iceland; and (4) to determine how many patients aged >75 years underwent pulmonary resection and to determine the reasons for the operation not being performed in patients with resectable disease. Three separate registries were used to identify cases. The histology database from the Department of Pathology at Landspitali University Hospital and the diagnosis and operation registry at Landspitali were used to identify patients who underwent surgery for NSCLC, and the Icelandic Cancer Registry was used to ...