National trends in lung cancer surgery

Trends in lung cancer surgery may reveal potential for improvement and are important for planning by care providers. Using data from the Cancer Registry of Norway, we analysed the outcomes of lung cancer surgery during the periods of 1994-95, 2000-01 and 2006-07. The Cox regression model was carried out to identify the period effect on survival. A total of 2201 patients were operated on. Surgery was centralized from 24 hospitals in the first two periods to 13 hospitals in the last. The resection rates varied from 6 to 31% across the counties. From the first to the last period, the national resection rate increased from 16 to 19% (P-trend = 0.001), and the 1-year survival rate increased from 73 to 82%. The proportion of resected patients in pathological stage I-II decreased from 87 to 83% (P-trend = 0.048), the proportion of pneumonectomies from 27 to 15% (P-trend < 0.001), and the rate of mortality within 30 days of the surgery from 4.8 to 3.0% (P-trend = 0.072). In the first two periods, 31% of these early deaths were caused by complications directly related to the surgical technique, whereas, in the latter period, no deaths were directly related. The only unfavourable trend was the waiting time between the final diagnostic procedure and surgery, which increased from 29 to 40 days throughout the three periods (P < 0.001). Survival (excluding those who died within 30 days) was significantly improved in the last period (risk ratio (RR): 0.72 (P < 0.001)). Despite an increased surgical waiting time, important aspects of lung cancer surgery, including resection rates, have improved in recent years.