Real-world guideline-based treatment of lung cancer improves short- and long-term outcomes and resection rate: A population-based study

Helminen, Olli; Valo, Johanna; Andersén, Heidi; Lautamäki, Anna; Vuohelainen, Vilma; Sihvo, Eero

doi:10.1016/j.lungcan.2019.12.002

Cited by 13 publications

(14 citation statements)

References 28 publications

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“…The actual rate in our districts is, however, significantly higher than the national surgical rate in Finland or any recently reported rate in Western countries. 3,11 Second, the surgical rates and outcomes in our area were improved by adherence to modern guidelinebased patient evaluation and treatment. 3 In the extended groups, the PET-CT rate of 95% and the brain imaging rate of 42.5% were the highest.…”

Section: Discussionmentioning

confidence: 99%

“…3,11 Second, the surgical rates and outcomes in our area were improved by adherence to modern guidelinebased patient evaluation and treatment. 3 In the extended groups, the PET-CT rate of 95% and the brain imaging rate of 42.5% were the highest. Accurate staging has been reported to reduce the number of futile operations, and improve the quality of surgery and survival.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Standardized low-technology exercise testing integrated in our routine risk assessment seemed to provide an excellent estimate of the physiological capacity of these patients. 3 Third, the overall high rate of minimally invasive approaches, anatomic lung resections, R0 resections, and formal lymphadenectomies, together with a low rate of major morbidity and 90-day mortality reflects the quality of the surgery. Overall number of examined lymph nodes in this population-based series was 11 being significantly higher than that of seven in the SEER database.…”

Section: Discussionmentioning

confidence: 99%

“…In September 2012, a modern guideline-based lung cancer surgery program was started at Central Finland Central Hospital by an experienced thoracic surgeon (ES). 3 Lung cancer surgery in Ostrobothnia was centralized to Central Finland Central Hospital in October 2014. All patients diagnosed with primary lung cancer in Central Finland and Ostrobothnia between January 1, 2013, and December 31, 2019, were considered for inclusion in this populationbased cohort study.…”

Section: Designmentioning

confidence: 99%

“…1,2 Based on our previous population-based study, the adherence to the modern guideline-based approach had a major impact on outcomes. 3 The best possible outcomes, on the other hand, in large STS and ESTS databases with 39% and 24% undergoing nonanatomic wedge resection, respectively, are most likely not reached. 4 Therefore, regardless of any guidelines, variations in surgical practice of even early stage lung cancer exist.…”

Section: Introductionmentioning

confidence: 99%

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Extended resections and other special cases in lung cancer surgery: Real‐world population‐based outcomes

et al. 2020

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Background: Lung cancer invading outside a lobe centrally or peripherally, or presenting with synchronous or metachronous tumors, requires a special approach. Here, we aimed to evaluate the rate and outcomes of surgery of these patients in a medium-volume practice using real-world, population-based data. Methods: All patients (n = 269) on whom lung cancer surgery was performed in Central Finland and Ostrobothnia between January 2013 and December 2019 were included. A total of 40 patients with sleeve (n = 18) or other extended resections (n = 9), multifocal diseases (n = 14), and other operated synchronous cancers (n = 3) required an extended or otherwise special surgical approach (extended group). Short-and long-term outcomes were compared to high-risk (n = 72) and normal patient groups (n = 157). Results: The rate of extended resection was 14.9%. The rates of PET-CT (95%), invasive staging (35%), and brain imaging (42.5%) were highest in extended group compared to other groups. Extended group had larger and higher rate of stage III tumors than high-risk and normal groups. All extended group patients underwent anatomic lung resection with better lymph node yield than the other two groups, with a neoadjuvant and/or adjuvant treatment rate of 70.0%. Major complications occurred in 7.5% in the extended group, 19.4% in the high-risk group, and 6.4% in the normal group; at one year, alive and living at home rates were 88.2%, 83.3%, and 97.8%, and overall five-year survival rates 75.6%, 62.4%, and 63.9% (P = 0.287), respectively. Conclusions: After guideline-based evaluation, a significant rate of these special cases can be resected with a low complication rate and good long-term survival in real-world practice.

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Section: Discussionmentioning

confidence: 99%