IMPROVING SURGICAL RESECTION RATE IN LUNG-CANCER

Background-Surgical resection is the recognised treatment of choice fo r patients with stage I or II non-small cell lung cancer (NSCLC). In t he UK surgical resection rates have remained far lower (<10%) than tho se achieved in Europe and the USA (>20%), despite the recent introduct ion of fast access investigation units. It remains unclear therefore w hy UK surgical resection rates lag so far behind those of other countr ies. Methods-A new quick access two stop investigation service was est ablished at Papworth in November 1995 to investigate all patients pres enting to any of three surrounding health districts with suspected lun g cancer. Once staging was complete, all patients with confirmed lung cancer were reviewed by a multidisciplinary team which included an onc ologist and a thoracic surgeon. Time from presentation to definitive t reatment and surgical resection rates were reviewed. Results-Two hundr ed and nine (76%) of a total of 275 consecutive patients investigated had confirmed lung cancer (28 small cell, 181 non-small cell). Of the remainder, eight patients (2%) had metastatic disease, four (1%) had o ther thoracic malignancy (thymoma, mesothelioma), four patients (1%) h ad benign thoracic tumours, and 50 (18%) had other non-malignant disea ses. Of the 181 patients with non-small cell primary lung cancer, 47 ( 25%) underwent successful surgical resection, of whom 59% had stage I and 21% stage II disease. The failed thoracotomy rate was 11%. Median time from presentation at the peripheral clinic to surgical resection was 5 weeks (range 1-13). Conclusion-Quick access investigation, high histological confirmation rates, routine CT scanning, and review of ev ery patient with confirmed lung cancer by a thoracic surgeon led to a substantial increase in the successful surgical resection rate. These results support the growing concern that many patients with operable t umours are being denied the chance of curative surgery in our present system.