Extended resections and other special cases in lung cancer surgery: Real-world population-based outcomes

BACKGROUND: Lung cancer invading outside a lobe centrally or peripherally, or presenting with synchronous or metachronous tumors, requires a special approach. Here, we aimed to evaluate the rate and outcomes of surgery of these patients in a medium-volume practice using real-world, population-based data.

METHODS: All patients (n = 269) on whom lung cancer surgery was performed in Central Finland and Ostrobothnia between January 2013 and December 2019 were included. A total of 40 patients with sleeve (n = 18) or other extended resections (n = 9), multifocal diseases (n = 14), and other operated synchronous cancers (n = 3) required an extended or otherwise special surgical approach (extended group). Short- and long-term outcomes were compared to high-risk (n = 72) and normal patient groups (n = 157).

RESULTS: The rate of extended resection was 14.9%. The rates of PET-CT (95%), invasive staging (35%), and brain imaging (42.5%) were highest in extended group compared to other groups. Extended group had larger and higher rate of stage III tumors than high-risk and normal groups. All extended group patients underwent anatomic lung resection with better lymph node yield than the other two groups, with a neoadjuvant and/or adjuvant treatment rate of 70.0%. Major complications occurred in 7.5% in the extended group, 19.4% in the high-risk group, and 6.4% in the normal group; at one year, alive and living at home rates were 88.2%, 83.3%, and 97.8%, and overall five-year survival rates 75.6%, 62.4%, and 63.9% (P = 0.287), respectively.

CONCLUSIONS: After guideline-based evaluation, a significant rate of these special cases can be resected with a low complication rate and good long-term survival in real-world practice.

KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Extended resections for lung cancer include tumors spreading outside the lung The rate of extended resection was 14.9% in a population-based setting Major complications occurred in 7.5% and five-year survival was 75.6% What this study adds Complication rate and long-term outcome were similar compared to normal patients Guideline-based evaluation results with excellent outcome in real-world practice.