Daniel Boffa2, Joshua D. Grab5, Mark S. Allen1, Henning A. Gaissert4, David H. Harpole3, Cameron D. Wright4; 1Mayo Clinic, Rochester, MN; 2Cleveland Clinic, Cleveland, OH; 3Duke University Medical Center, Durham, NC; 4Massachusetts General Hospital, Boston, MA; 5Duke Clinical Research Institute, Durham, NC
Objective: We wish to investigate the surgical management of primary lung tumors by board-certified thoracic surgeons that participate in the STS general thoracic database.Methods: We identified all pulmonary resections registered in the STS General Thoracic Database (GTDB) categorized as primary lung tumor from 1999 to 2005. Among 25,801 procedures, a diagnosis of a primary lung tumor was found in 7,380 patients of whom 4,384 underwent pulmonary resections.
Results: There were 2,166 men and 2,218 women with a median age of 68 years (range 6 to 104). Comorbidity was present in 2,990 patients (68%) and included hypertension in 49%, body mass index = 30 in 26%, coronary artery disease in 20%, and diabetes mellitus in 12%. A history of smoking was present in 84% of patients. Pulmonary function data (available in 81% of patients) showed a median predicted FEV1 of 78% and median predicted DLCO of 71%. Mediastinoscopy was performed at the time of resection in 659 patients (15%). The surgical approach consisted of lateral thoracotomy in 3,351 patients (76%), video assisted thoracic surgery in 974 (22%), and others in 59 (1.3%). The type of resection was single wedge resection in 602 (13.7%), multiple wedge resections in 197 (4.5%), segmentectomy in 234 (5.3%), lobectomy in 2,909 (66%), bilobectomy in 175 (4.0%), and pneumonectomy in 267 (6.1%). Mediastinal lymph node dissection was performed in 1,809 (41%), nodal sampling in 327 (7.5%) and nodal biopsy in 231 (5.3%). Pathological stage was stated in 2,599 (59.3%) procedures and was stage 0 in 8 (0.31%), IA in 1,110 (43%), IB in 684 (26%), IIA in 101 (3.9%), IIB in 230 (8.8%), IIIA in 240 (9.2%), IIIB in 104 (4.0%) and IV in 122 (4.7%). Operative mortality was 2.0 % (86 patients). One or more postoperative events occurred in 38%: atrial arrythmia in 472 (10.8%), air leak in 361 (8.2%), blood transfusion in 162 (3.7%), pneumonia in 147 (3.4%), reintubation in 145 (3.3%) or atelectasis in 143 (3.3%). Median length of stay was 5 days (range 0 to 277).
Conclusion: The STS GTDB provides information about the current surgical management of lung cancer. A similar number of men and women underwent resection and comorbidities were frequent. Thoracotomy remains the preferred operative approach. Operative mortality is low, while postoperative events are common.
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