Resection rate and outcome of pulmonary resections for non-small-cell lung cancer: a nationwide study from Iceland.

BACKGROUND: The proportion of patients with non-small-cell lung cancer (NSCLC) who undergo surgery with curative intent is one measure of effectiveness in treating lung cancer. To the best of our knowledge, surgical resection rate (SRR) for a whole nation has never been reported before. We studied the SRR and surgical outcome of NSCLC patients in Iceland during a recent 15-year period. METHODS: This was a retrospective study of all pulmonary resections performed with curative intent for NSCLC in Iceland from 1994 to 2008. Information was retrieved from medical records and from the Icelandic Cancer Registry. Patient demographics, postoperative tumor, node, metastasis stage, overall survival, and complication rates were compared over three 5-year periods. RESULTS: Of 1530 confirmed cases of NSCLC, 404 were resected, giving an SRR of 26.4%, which did not change significantly during the study period. Minor and major complication rates were 37.4% and 8.7%, respectively. Operative mortality rates were 0.7% for lobectomy, 3.3% for pneumonectomy, and 0% for lesser resection. Five-year survival after all procedures was 40.7% and improved from the first to the last 5-year period (34.8% versus 43.8%, p = 0.04). Five-year survival for stages I and II together was 46.8%, with no significant change in stage distribution between periods. Five-year survival after pneumonectomy was 22.0%, which was significantly lower than for lobectomy (44.6%) and lesser resection (40.7%) (p < 0.005). Unoperated patients had a 5-year survival of 4.8%, as compared to 12.4% for all the NSCLC patients together. CONCLUSION: Compared with most other published studies, the SRR of NSCLC in Iceland is high. Short-term outcome is good, with a low rate of major complications and an operative mortality of only 1.0%. Five-year survival improved significantly over the study period.

[Postoperative complications following lobectomy for lung cancer in Iceland during 1999-2008]. / Fylgikvillar bladnámsadgerda vid lungnakrabbameini á Islandi 1999-2008.

OBJECTIVE: Non small cell lung cancer (NSCLC) is the second most common cancer in Iceland. We studied the indications and surgical outcome of lobectomy for NSCLC in Iceland. MATERIALS AND METHODS: 213 consecutive patients underwent lobectomy for NSCLC between 1999 and 2008. Data on indications, histology, TNM-stage and complications were analysed, and logistic regression used to assess outcome predictors. RESULTS: The majority of patients (60%) were referred because of symptoms, whereas 40% were asymptomatic. Adenocarcinoma (62%) and squamous cell carcinoma (29%) were the most frequent histological types. Operative staging showed that 59.6% of cases were stage I, 17.8% were stage II, 7% were stage IIIA and 14.6% were stage IIIB or IV. Mediastinoscopy was performed in 13.6% of cases. Mean operative time was 128 min., operative bleeding 580 ml and median hospital stay 10 days. Sixteen patients (7.5%) had major complications and 36 (17.5%) had minor complications, such as atrial fibrillation and pneumonia. Twelve patients required reoperation, most often due to bleeding, but two had empyema and one had a bronchopleural fistula. Older patients with high ASA scores and extensive smoking history were at increased risk for complications. No patient died within 30 days of surgery whereas two (0,9%) died within 90 days of surgery. CONCLUSIONS: The results of lobectomy for NSCLC in Iceland are excellent in relation to operative mortality and short term complications.

[Factors predictive of survival after lobectomy for non-small cell lung cancer in Iceland during 1999-2008]. / Forspárbaettir lífshorfa eftir bladnám vid lungnakrabbameini á Islandi 1999-2008.

OBJECTIVE: To study the impact of TNM stage and various preoperative functional parameters on survival in patients who underwent lobectomy for non-small cell lung cancer (NSCLC) in Iceland from 1999 to 2008. MATERIALS AND METHODS: Retrospective study including 213 patients (mean age 66.9 yrs, equal male/female ratio) that underwent lobectomy for NSCLC. Tumors were staged by the TNM staging system, survival was estimated by the Kaplan-Meier method and prognostic factors of survival studied using the Cox proportional hazards regression model. RESULTS: Survival at 1 year was 82.7% and 45.1% at 5 years. Operative mortality at 30 days was 0%. Most tumors were found to be in stage I (59.6%) or stage II (17.8%) and 7% were stage IIIA, whereas 14.6% were in stage IIIB or IV. Using multivariate analysis; advancing stage, increasing tumor size, reduced lung function and history of arrhythmia, predicted worse survival, whereas adenocarcinoma histology was a positive prognostic factor (HR 0.5, p=0.002) when compared to other histological types. CONCLUSIONS: Survival for patients undergoing lobectomy for operable non-small cell lung cancer in Iceland is comparable with other studies. Advanced stage, tumor size, reduced lung function and arrhythmia were negative predictors of survival, but in contrast to many but not all studies adenocarcinoma histology predicted a better prognosis compared to other tumor types.