Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival

Abstract

Introduction: Lobectomy is the standard curative treatment for non-small cell carcinoma (NSCLC) of the lung. Most studies on lobectomy have focused on short-term outcome and 30-day mortality. The aim of this study was to determine both short-term and long-term surgical outcome in all patients who underwent lobectomy for NSCLC in Iceland over a 24-year period. Material and methods: The study involved 489 consecutive patients with NSCLC who underwent lobectomy with curative intent in Iceland, 1991Iceland, -2014. Patient demographics, pTNM stage, rate of perioperative complications, and 30-day mortality were registered. Overall survival was analyzed with the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate factors that were prognostic of overall mortality. To study trends in survival, the study period was divided into six 4-year periods. The median follow-up time was 42 months and no patients were lost to follow-up. Results: The average age of the patients was 67 years and 53.8% were female. The pTNM disease stage was IA in 148 patients (30.0%), IB in 125 patients (25.4%), IIA in 96 patients (19.5%), and IIB in 50 patients (10.1%), but 74 (15.0%) were found to be stage IIIA, most often diagnosed perioperatively. The total rate of major complications was 4.7%. Thirty-day mortality was 0.6% (three patients). One-and 5-year overall survival was 85.0% and 49.2%, respectively, with 3-year survival improving from 48.3% to 72.8% between the periods 1991-1994 and 2011-2014 (p ¼ .0004). Advanced TNM stage and age were independent negative prognostic factors for all-cause mortality, and later calendar year and free surgical margins were independent predictors of improved survival. Conclusions: The short-term outcome of lobectomy for NSCLC in this population-based study was excellent, as reflected in the low 30-day mortality and low rate of major complications. The long-term survival was acceptable and the overall 3-year survival had improved significantly during the study period.

Patterns of survival and surgical treatment in lung cancer patients in Estonia by histologic type and stage, 1996–2016

“…According to data from one cancer center in Estonia, the largest group of LC cases undergoing radical resection was stage IA, but a substantial number of stage IB-III patients were also resected [26]. In Iceland, 15% of patients who underwent lobectomy had stage IIIA disease, which was usually detected postoperatively [27]. Treatment complications and comorbidities have been shown to be important causes of death in early stage LC [28].…”

A novel autophagy‐related lncRNA survival model for lung adenocarcinoma

“…Despite the continuous progress in the technology of cancer diagnosis and treatment, the mortality rate of lung cancer remains high. One reason is that some patients are diagnosed with advanced lung cancer, and the other is that the existing guided staging system is not accurate in predicting the prognosis of lung cancer; as a result, some patients with early lung cancer did not receive adjuvant therapy after operation, which led to the recurrence or metastasis of lung cancer 3,4 . Therefore, it is necessary to update the staging system of the existing guidelines.…”

Pivotal role of video‐assisted thoracoscopic surgery in improving survival outcome of stage I non‐small cell lung cancer in day surgery patients

“…VATS is the most common surgery for the thoracic surgery department performed at the day surgery center in recent years 25 . Successful results from a randomized clinical trial were reported in 1994, and lobectomy is considered the gold standard of treatment for NSCLC 26 . However, a number of studies have revealed that lobectomy can substitute sublobar resection for early stage or small peripheral stage I NSCLCs, including wedge resection and segmentectomy, as outcomes are comparable to those after lobectomy 26–28 .…”