Elsevier

Surgical Oncology

Volume 11, Issue 4, December 2002, Pages 263-266
Surgical Oncology

Review
Lung cancer surgery: acceptable morbidity and mortality, expected results and quality control

https://doi.org/10.1016/S0960-7404(02)00055-5Get rights and content

Introduction

In non-small cell lung cancer, surgical excision remains the treatment of choice for those tumors limited to the thoracic cavity when a complete (R0) resection can be anticipated. Since its successful introduction over 70 years ago, improvements in clinical staging, preoperative assessment, anesthesia, surgical techniques and perioperative care have allowed the surgeon to offer this approach with the expectation that patients will fare well postoperatively and will potentially be cured of their cancer. Despite these improvements, there is still significant morbidity and mortality associated with pulmonary resections and, unfortunately, a minority of surgically resected patients will remain alive, disease-free five years later. Indeed, in most series, only 40–45% of patients undergoing surgical resection for the management of primary lung cancer will survive five years. It is the purpose of this paper to discuss the expected results following surgical resection, including: the morbidity and mortality of such procedures, the expected five year survival rates and various quality control issues that are now readily identifiable in lung cancer surgery.

Section snippets

Morbidity

Despite advances in patient selection and perioperative care, postoperative morbidity remains a persisting problem following pulmonary resection (Table 1). In most retrospective series, approximately 30% of patients undergoing such resections will encounter major (10%) or minor (20%) morbidity [1], [2], [3]. In the only prospective analysis, 48% of patients suffered a morbid complication (27% major; 21% minor) [4]. Over 80% of patients suffering from lung cancer have a history of cigarette

Mortality

The postoperative mortality rate for surgical resection for lung cancer continues to decrease as attention to patient selection, perioperative management and prevention of complications improve. In 1983, we reported the 30 day mortality following surgical resection for lung cancer from the Lung Cancer Study Group centres. A more recent analysis from a Japanese consortium has shown an improvement in these mortality rates [8], [9] (Table 4).

Similar to morbidity, the mortality from pulmonary

Cancer free survival

The survival following surgical resection for lung cancer is most dependent on the final pathologic staging and completeness of resection. Whereas completely resected T1N0 lung cancer patients have up to an 80% cancer-free survival at 5 years, this survival rate decreases significantly stage by stage (Table 6) [14], [15], [16], [17]. Site of cancer recurrence, however, is less stage-dependent. Approximately two-thirds of all first recurrences are identified in distant sites. The most common

Quality control

In lung cancer surgery, as with other highly specialized surgical procedures, the evidence is accruing that surgeons specifically trained in thoracic surgery can deliver this treatment with less morbidity and mortality. Larger volume practices also appear to improve results both early and late. Not only does postoperative mortality and morbidity decrease, but it appears that long-term survival also improves [12], [13]. Undoubtedly, this reflects highly structured training in cardiothoracic

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