Huge increase in lung cancer surgery but still some way to go, says new audit
- Published on Thursday, 03 November 2011 11:34
- Posted by Scott Buckler
The number of lung cancer patients benefiting from life-saving surgery has shot up by 60 per cent while the operative mortality rate has halved in recent years as a new generation of specialist lung surgeons start to come through into the NHS
In the last year alone the number of lung cancer operations has increased by more than 17 per cent. These are among the findings of a comprehensive new audit from the Society for Cardiothoracic surgery [SCTS]. The study also finds that new scanning technology has led to more accurate decisions on which patients could benefit from an operation; but points to the need for more training in minimally-invasive techniques.
The report, the National Thoracic Surgery Activity & Outcomes Report 2011, tracks the results of more than 400,000 operations from 1980 to 2010 and includes hospital-specific data for the past three years. Among the findings are:
• More patients treated – the number of patients undergoing primary lung cancer resection had remained relatively unchanged between 1980 and 2006 at between 3,000 and 4,000 operations a year – since then the figure has grown every year to 5,265 in 2010.
• Lower operative mortality - operative mortality rates have almost halved over the last decade from 3.8 per cent to 2.1 per cent. This comes despite the increased number of frail patients now being treated.
• Slow progress on new techniques - Video Assisted Thoracic Surgery (VATS) is a keyhole surgery technique where surgeons can remove diseased lung tissue via a small incision in a patient’s side without opening the ribcage. Progress in its use has been slow since its introduction in 1993 and currently only around 35 per cent of operations are undertaken by VATS, with access widely variable from hospital to
hospital. VATS is particularly suited to early tumours but is of most benefit in the elderly and those with poorer lung function. Although this technique is not suitable for all cases, more surgeons need access to specialist training if as many patients as possible are to benefit from reduced pain and faster recovery.
• Better decisions and scanning – in the pre-CT scanning era, operations where a patient was taken to the operating theatre and had a major chest incision only for the surgeon to be unable to remove the tumour because it was too dangerous represented up to 25 per cent of lung cancer operations. The rate for this terrible outcome (so call “open/ close” operations) has fallen year on year as better scanning and peri-operative care enables better patient selection; for 2010 the figure was just 1.9 per cent. Not all lung cancer tumours are operable - doctors believe around twenty to thirty per cent of patients could benefit from an operation, but the rate of operations in the UK has, until recently, been much lower, lagging behind other European countries. The dramatic increase in lung cancer surgery, as described in this report, will undoubtedly have helped to correct this deficit and can be expected to lead to improved survival rates for patients. Data from the cancer networks shows the overall median England & Wales lung cancer resection rate is 18 per cent, but that variation exists with the lowest region providing operations for just 12 per cent of patient compared to the highest operating on more than 23 per cent.
Professor David Taggart, President of SCTS, said: “Increased rates of lung cancer surgery have been linked to improved survival for patients. Although the surgery carries risks, studies have shown that for every person who die as a result of surgery 35 people who would otherwise have died from their cancer are still alive five years on – so the potential to improve the outlook for this group is huge if we continue the improvements made in the past few years. If we could get the rate of operations across the country up to the standard of the best performing areas then at least thousand additional lives could be saved each year.”
Professor Norman Williams, President of the Royal College of Surgeons said: “This audit shows that decisions by the SCTS and Royal College of Surgeons to introduce specialist thoracic surgery training a decade ago are starting to bear fruit. The first of the consultantstrained in this way are now coming through the system and more hospitals are appointing lung specialist surgeons. The presence of these new surgeons is enabling the teams who care for lung cancer patients to make more confident decisions to offer surgery.”
Professor Stephen Spiro, Deputy Chair of the British Lung Foundation and lung cancer specialist, said: “The British Lung Foundation welcomes the introduction of more dedicated thoracic surgeons and the benefits are now becoming very clear to see. As more lung cancer patients are offered surgery they have a much better chance of an uncomplicated recovery. It is encouraging to see this happening in the UK, bringing us into line with practice in other European Countries and the USA.”
The National Thoracic Surgery Activity & Outcomes Report 2011 includes registry data from every hospital in the country and a more detailed database for 12 hospitals. The database section includes more specific data about the health and age of patients and SCTS aim to grow this more detailed audit to replace the registry in coming years. The report will be available to download from: www.scts.org.