Resection rates and postoperative mortality in 7,899 patients with lung cancer

Abstract

Postoperative death used to be an important complication of resections for lung cancer, especially in elderly patients. To support decision making in a general situation, contemporary results and prognostic factors were evaluated.The computer records of 7899 lung cancer patients, diagnosed from 1984 until 1992 in hospitals connected to the Rotterdam Cancer Registry, were analysed to evaluate resection rates and 30 day postoperative mortality.Resections were carried out in 20% of all patients. In patients 70 yrs of age and older, the resection rate was 14%, and in younger patients 26%. The postoperative mortality was 3.1%; 3.6% for males and 0.4% for females. According to multivariate analysis, age and extent of surgery were the major determinants of operative risk. For patients aged 0-59, 60-69 and ≥70, postoperative mortality rates were 1.4, 3.5 and 4.0%, respectively. The operative risk was 5.7% after pneumonectomy, 4.4% after bilobectomy, and 1.4% after lesser resections. Pneumonectomies were performed less often in elderly patients: 27% of operations in patients ≥70 yrs versus 37% of operations in younger patients.Age appears to be related to treatment choice and postoperative mortality in patients with lung cancer. However, even in patients over 70 yrs of age, resections can be performed at acceptable risk, implying that chronological age should not automatically determine treatment decisions.

Exercise capacity and extent of resection as predictors of surgical risk in lung cancer

“…The estimated extent of lung resection in the present patients also entered the regression model as statistically significant, which is consistent with reports in the literature [3,22,23] and clinical expectancy. Its predictive value is yet to be confirmed by further studies.…”

“…In a recent representative survey [3] in 7,899 patients, a mortality rate of 8% for pneumonectomy and 3% after lesser resection was found in patients of >70 yrs of age, compared to an overall 1.4% mortality rate in patients of <60 yrs of age. Interestingly, age was not an independent predictor for postoperative complications in the present regression analysis.…”

“…Nevertheless, resection rates are quite low and vary significantly between different countries. Cancer registrybased studies show resection rates of only 10±20% in Europe [3,4]. It is possible, that overly restrictive preoperative selection and preselection by nonspecialists, for example for patients >70 yrs of age, preclude a potentially curative therapy for some patients.…”

Gender differences in mortality following non-cardiovascular surgery: an observational study

“…6,7 Studies with a large sex bias in referral for surgery present difficulties in interpretation, because it is unclear which selection factors led to this discrepancy. Our study eliminated this problem by analyzing a subset consisting of only the surgical services without a large sex bias in presentation for surgery.…”

“…For instance, an association has been found between males and an increase in postoperative mortality in pulmonary resection and hip replacement. [6][7][8] Males have also been associated with other adverse outcomes following noncardiovascular surgery, such as increased intensive care unit (ICU) admissions and rates of sepsis. 9 In a study of surgical ICU patients, males were shown to have a poorer prognosis compared with females.…”