What has changed in the surgical treatment strategies of non-small cell lung cancer in twenty years? A single centre experience

Objective: Non-small cell lung cancer (NSCLC) is a multifactorial disease and differences in surgical patient characteristics may develop over the years. The aim of this study is to evaluate the patients undergone curative surgical resection due to NSCLC in the last 20 years in our centre and analyze the changes by means of demographics, surgical strategies and histopathology.

Materials and Methods: In this retrospective single-center cohort study, 1995 patients, who had undergone lobectomy, bilobectomy, or pneumonectomy due to primary NSCLC between January 1997 and January 2017, were analyzed. Patients were divided into two groups; Group I is formed by the patients who were operated in the first ten years and Group II included the patients who were operated in the last ten years .

Results: 77% of the patients were operated in the last decade (458 vs 1537). Sleeve lobectomies performed in Group II reduced the rate of pneumonectomy from 37% to 20% (p<0.001) The rates of operated adenocarcinomas increased significantly during the study period, arising from 31.4% to 36.2% (p = 0.049). 30 and 90-day postoperative mortality rates were 4.6% and 8.5% in Group I, whereas these rates were 4.1% and 5.7% in Group II, respectively (p = 0.69 and 0.037 respectively). When the groups were compared, the median and 5-year survival rates were 44.1 months (95% CI, 35.6-52.6) and 42.9% in Group I, and 73.6 months (95% CI, 63.3-83.9) and 53.9% in Group II, respectively (p<0.001).

Conclusions: This study demonstrates an improvement in long-term outcome after lung cancer surgery with an increasing rate of surgery in the last decade. There was an increase in the female gender and adenocarcinoma histology. Pneumonectomy rate and postoperative N2 disease rates have decreased with advancing preoperative evaluation techniques and parenchyma-saving surgical methods. Postoperative mortality has decreased and survival has been lengthened.

Cite this article as: Üçvet A, Gürsoy S, Yazgan S. Changes in the Surgical Treatment Strategies for Nonsmall Cell Lung Cancer in the Past 20 Years: A Single-Center Experience. Turk Thorac J 2020; 21(1): 8-13.