Thorax 1998;53:445-449 ( June )

Improving surgical resection rate in lung cancer

Clare Laroche, Frank Wells, Richard Coulden, Susan Stewart, Martin Goddard, Erica Lowry, Alan Price, David Gilligan

Thoracic Oncology Unit, Papworth & Addenbrooke's NHS Trusts, Papworth Hospital , Papworth Everard, Cambridgeshire CB3 8RE, UK

Correspondence to: Dr C M Laroche.

Received 24 October 1997; Returned to authors 5 January 1998; Revised version received 16 February 1998; Accepted for publication 27 February 1998

BACKGROUNDSurgical resection is the recognised treatment of choice for patients with stage I or II non-small cell lung cancer (NSCLC). In the UK surgical resection rates have remained far lower (<10%) than those achieved in Europe and the USA (>20%), despite the recent introduction of fast access investigation units. It remains unclear therefore why UK surgical resection rates lag so far behind those of other countries.
METHODSA new quick access two stop investigation service was established at Papworth in November 1995 to investigate all patients presenting to any of three surrounding health districts with suspected lung cancer. Once staging was complete, all patients with confirmed lung cancer were reviewed by a multidisciplinary team which included an oncologist and a thoracic surgeon. Time from presentation to definitive treatment and surgical resection rates were reviewed.
RESULTSTwo hundred and nine (76%) of a total of 275 consecutive patients investigated had confirmed lung cancer (28 small cell, 181 non-small cell). Of the remainder, eight patients (2%) had metastatic disease, four (1%) had other thoracic malignancy (thymoma, mesothelioma), four patients (1%) had benign thoracic tumours, and 50 (18%) had other non-malignant diseases. Of the 181 patients with non-small cell primary lung cancer, 47 (25%) underwent successful surgical resection, of whom 59% had stage I and 21% stage II disease. The failed thoracotomy rate was 11%. Median time from presentation at the peripheral clinic to surgical resection was 5 weeks (range 1-13).
CONCLUSIONQuick access investigation, high histological confirmation rates, routine CT scanning, and review of every patient with confirmed lung cancer by a thoracic surgeon led to a substantial increase in the successful surgical resection rate. These results support the growing concern that many patients with operable tumours are being denied the chance of curative surgery in our present system.

Keywords: lung cancer; surgical resection rate

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© 1998 by Thorax
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