Surgical resection of lung cancer England: more operations but no trials to test their effectiveness
- 1Clinical Operational Research Unit, University College London, London, UK
- 2Department of Surgery, University College London, London, UK
- 3Academic Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
- 4National Institute for Health and Clinical Excellence, London, UK
- Correspondence to Professor Tom Treasure, Cardiothoracic Surgery, Clinical Operational Research Unit, Department of Mathematics, University College London, 4 Taviton Street, London WC1H 0BT, UK;
Contributors TT provided the first draft. All the authors are collaborators and have contributed to the ideas in this paper and discussions on them.
Ten years ago a joint working group of The British Thoracic Society and the Society for Thoracic Surgery in Great Britain in Ireland published its findings, concluding that there was ‘critical under-provision of Thoracic Surgery in the UK’.1 ,2 The situation has improved according to Lung Cancer Data (LUCADA),3 the National Lung Cancer Audit,4 and the English Cancer Repository Dataset reported in this number of Thorax.5 The English Cancer Repository Dataset study found that the proportion of patients with non-small cell lung cancer undergoing surgery has risen to 10.6% from 8.8% in 1998, the situation that prompted the formation of the working party. The data provide evidence that there is now better access to thoracic surgery in the management of lung cancer and that the drive by professional societies to achieve this has met with success. The critical question now is whether, on existing evidence, it is reasonable to believe that simply increasing lung cancer resection rates will result in overall better outcomes for future patients with lung cancer.
Overall survival for lung cancer remains extremely poor. In bowel cancer, 5-year survival has steadily increased from around 20% to 50% (figure 1) while that for lung cancer remains under 10% with negligible improvement over 40 years (figure 2). The lung cancer patients who have surgery are, by selection, the most favourable decile, yet fewer than one in four operated patients were alive 5 years later according to data in the National Lung Cancer Audit,4 the same as in patients operated on between 1949 and 1983.6 In the intervening 30 years, there have been fundamental changes in endoscopy, imaging, staging and the …