Improving surgical resection rate in lung cancer

Our plain-English summary of Improving surgical resection rate in lung cancer, by C. Laroche, F. Wells, R. Coulden, et al (Thorax, 1998).

The study

• Authors: C. Laroche, F. Wells, R. Coulden, S. Stewart, M. Goddard, E. Lowry, A. Price, D. Gilligan
• Journal: Thorax
• Published: 1998;53(6):445-9
• Type of article: Comment
• Cited by: 97 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Surgical resection is the recognised treatment of choice for patients with stage I or II non-small cell lung cancer (NSCLC). In the UK surgical resection rates have remained far lower (< 10%) than those achieved in Europe and the USA (> 20%), despite the recent introduction of fast access investigation units. It remains unclear therefore why UK surgical resection rates lag so far behind those of other countries.

Methods: A new quick access two stop investigation service was established at Papworth in November 1995 to investigate all patients presenting to any of three surrounding health districts with suspected lung cancer. Once staging was complete, all patients with confirmed lung cancer were reviewed by a multidisciplinary team which included an oncologist and a thoracic surgeon. Time from presentation to definitive treatment and surgical resection rates were reviewed.

Results: Two hundred and nine (76%) of a total of 275 consecutive patients investigated had confirmed lung cancer (28 small cell, 181 non-small cell). Of the remainder, eight patients (2%) had metastatic disease, four (1%) had other thoracic malignancy (thymoma, mesothelioma), four patients (1%) had benign thoracic tumours, and 50 (18%) had other non-malignant diseases. Of the 181 patients with non-small cell primary lung cancer, 47 (25%) underwent successful surgical resection, of whom 59% had stage I and 21% stage II disease. The failed thoracotomy rate was 11%. Median time from presentation at the peripheral clinic to surgical resection was 5 weeks (range 1-13).

Conclusion: Quick access investigation, high histological confirmation rates, routine CT scanning, and review of every patient with confirmed lung cancer by a thoracic surgeon led to a substantial increase in the successful surgical resection rate. These results support the growing concern that many patients with operable tumours are being denied the chance of curative surgery in our present system.

In plain English

This article was not a study of asbestos. It reported the first year (November 1995 to December 1996) of a new "two stop" investigation service at Papworth Hospital, UK, for patients with suspected lung cancer from three surrounding health districts. Every patient had a CT scan, and every patient with confirmed lung cancer was reviewed by a team that included a thoracic surgeon and an oncologist. Of 275 patients investigated, 209 had primary lung cancer (181 non-small cell, 28 small cell). Three had mesothelioma, and the article gave no further details about them. Of the 181 patients with non-small cell lung cancer, 53 (29%) had a thoracotomy, and the overall successful resection rate was 25%. In six of those 53 operations (11%) the tumour could not be removed. Median time from presentation at the local clinic to surgery was 5 weeks. The authors concluded that a set protocol with universal CT staging and surgical review could match resection rates reported in Europe and the USA. They said patients must be followed to see whether long-term outcomes improve.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Audit of the first year of a new hospital lung cancer investigation service (consecutive patient series)
• Who was studied: 275 consecutive patients with suspected lung cancer (171 men, 104 women) investigated at Papworth Hospital, Cambridgeshire, UK, over 13 months, referred mainly from three district general hospitals (Cambridge, Huntingdon, Bury St Edmunds)
• Exposure: No asbestos or other fiber exposure was studied or reported. What the article examined was a standardised "two stop" investigation service: CT staging of every patient and review of every confirmed lung cancer by a multidisciplinary team that included a thoracic surgeon.
• Main results:
  • Of the 275 patients, 209 had primary lung cancer (181 non-small cell, 28 small cell)
  • Three of the 275 patients had mesothelioma and one had malignant thymoma; the type of mesothelioma was not stated
  • Of the 181 patients with non-small cell lung cancer, 53 (29%) underwent thoracotomy: 32 (18%) successful lobectomy, 13 (7%) pneumonectomy, and two segmentectomy
  • Resection was unsuccessful in six of the 53 patients who had thoracotomy (11%)
  • There was one death after surgery, eight days after lobectomy
  • Among non-small cell lung cancer patients, the overall successful resection rate was 25%; 38 of the resected patients (80%) had stage I or II disease
  • Median time from presentation at the peripheral clinic to surgical resection was 5 weeks (range 1 to 13)
• The authors' conclusion: The authors concluded that investigating patients by a set protocol including universal CT staging and surgical review made it possible to match surgical resection rates reported in Europe and the USA
• Limitations the authors state:
  • It was not yet known whether the higher resection rate leads to better long-term outcomes; the cohort needs follow-up
  • About 50 patients bypassed the investigation service and went directly to the oncologist, so they were not included
  • Failed thoracotomies still happened even though every patient had a CT scan

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Surgical Resection, Lung Cancer, Non-Small Cell Lung Cancer, Staging, Multidisciplinary Team, Mesothelioma, Thoracotomy.

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