Jarmo Gunn1, Johanna Valo2, Jussi Sipilä3,4,5, Päivi Rautava6,7, Eero Sihvo2, Ville Kytö1,8. 1. Heart Center, Turku University Hospital, Turku, Finland. 2. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. 3. Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland. 4. Department of Neurology, University of Turku, Turku, Finland. 5. Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland. 6. Clinical Research Center, Turku University Hospital, Turku, Finland. 7. Department of Public Health, University of Turku, Turku, Finland. 8. Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
Abstract
OBJECTIVES: The aim of this study was to investigate the current trends and results of lung cancer surgery in Finland at the population level. METHODS: Three compulsory national registries provided the data on surgical treatment of lung cancer during 2004 and 2014. Outcomes of interest were all-cause mortality, population level surgical rates and frequencies of resections. The data were divided into 2 eras to analyse changes in treatment strategies and baseline characteristics: 2004-2009 and 2010-2014. RESULTS: A total of 3621 patients underwent lung resections for cancer during the study period. The mean age of the patients was 65.8 years. During the study period, the patients were older and Charlson comorbidity index score of the patients increased (P < 0.001 for both). Simultaneously, the rate of surgery (from 12.8% to 14.4%, P = 0.001) and the rate of video-assisted thoracoscopic surgery increased (from 7.3% to 31.9%, P < 0.001). The rate of pneumonectomy decreased from 12.7% to 7.5% (P < 0.001). Mortality was 2.3% at 30 days and 4.3% at 90 days without significant differences between eras. Overall survival was 85% at 1 year and 50.2% at 5 years. Long-term survival improved significantly during the study from 53% to 60.1% at 4 years (P < 0.001). CONCLUSIONS: This nationwide population-based study demonstrates an improvement in long-term outcome after lung cancer surgery despite an increasing age and comorbidity burden concomitantly with an increasing rate of surgery. This suggests that video-assisted thoracoscopic surgery can be offered to more patients with more comorbidities while still improving lung cancer survival.
OBJECTIVES: The aim of this study was to investigate the current trends and results of lung cancer surgery in Finland at the population level. METHODS: Three compulsory national registries provided the data on surgical treatment of lung cancer during 2004 and 2014. Outcomes of interest were all-cause mortality, population level surgical rates and frequencies of resections. The data were divided into 2 eras to analyse changes in treatment strategies and baseline characteristics: 2004-2009 and 2010-2014. RESULTS: A total of 3621 patients underwent lung resections for cancer during the study period. The mean age of the patients was 65.8 years. During the study period, the patients were older and Charlson comorbidity index score of the patients increased (P < 0.001 for both). Simultaneously, the rate of surgery (from 12.8% to 14.4%, P = 0.001) and the rate of video-assisted thoracoscopic surgery increased (from 7.3% to 31.9%, P < 0.001). The rate of pneumonectomy decreased from 12.7% to 7.5% (P < 0.001). Mortality was 2.3% at 30 days and 4.3% at 90 days without significant differences between eras. Overall survival was 85% at 1 year and 50.2% at 5 years. Long-term survival improved significantly during the study from 53% to 60.1% at 4 years (P < 0.001). CONCLUSIONS: This nationwide population-based study demonstrates an improvement in long-term outcome after lung cancer surgery despite an increasing age and comorbidity burden concomitantly with an increasing rate of surgery. This suggests that video-assisted thoracoscopic surgery can be offered to more patients with more comorbidities while still improving lung cancer survival.
Authors: David M Cutler; Kaushik Ghosh; Kassandra L Messer; Trivellore Raghunathan; Allison B Rosen; Susan T Stewart Journal: Am Econ Rev Date: 2022-02