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Title: Surgeons Specialising in Lung Cancer Perform Better Quality Surgery: Presented at STS

"Surgeons Specialising in Lung Cancer Perform Better Quality Surgery: Presented at STS"

By Jill Stein SAN ANTONIO, TX -- January 28, 2004 -- New findings suggest that surgeons who specialise in lung cancer are more likely to perform a complete resection and a more adequate lymphadenectomy in patients with limited small-cell lung cancer than other surgeons. The results were announced here on January 27th at the Society of Thoracic Surgeons 40th Annual Meeting. Dr. Wayne. L. Hofstetter, University of California at Los Angeles, Los Angeles, California, United States, and associates analysed data from 832 prospectively randomised patients undergoing treatment for limited small-cell lung cancer. Patients in their study were drawn from the North American Lung Cancer Study Group (LCSG), a cooperative study group formed in 1977 and comprising surgeons whose practices were largely confined to thoracic oncology surgery. One of the group's protocols allowed two cooperative groups who did not specialise in lung cancer surgery to participate. Patients who responded to chemotherapy were randomised to prophylactic cranial and thoracic radiation or resection followed by radiation. Surgeons were instructed to extensively stage and resect all residual tumour. Patients were followed longitudinally for 2 years. The quality of surgery was assessed by quantifying the surgeon's ability to achieve resection, the adequacy of lymphadenectomy and overall survival. The trial excluded patients with "minimal" small-cell lung cancers, which included early stage or incidentally identified cancers. Overall, 70 patients in the study were randomized to surgery; 51 were operated on by surgeons specialising in lung cancer and 19 by surgeons not specialising in lung cancer. In-hospital mortality was 3% for both groups. Twelve patients underwent exploratory surgery but not resection. Eleven percent of 51 unsuccessful attempted resections were performed by surgeons who specialised in lung cancer compared to 32% of 19 unsuccessful attempted resections performed by surgeons not specialising in lung cancer (P = .07). Physicians specialising in lung cancer recovered a mean of 7.96 N2-level lymph nodes from the mediastinum versus 4.28 by surgeons who did not specialise in lung cancer (P = .008). "This represents a significant improvement in quality of surgery in the patients operated on by the specialist group," Dr. Hofstetter noted. Patients operated on by lung cancer specialists survived a median of 18 months versus eight months for patients whose surgeon was not a lung cancer specialist, P = .076. Dr. Hofstetter said the study is, to his knowledge, the first to compare differences in outcomes between groups of surgeons treating post-induction therapy lung cancer patients. "The results suggest that thoracic oncology surgery should be practiced by surgeons who are specifically trained and focused on thoracic oncology patients," he added. [Study title: Surgeons Specializing in Lung Cancer Perform Higher Quality Resections. Abstract 38]

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