Too high-risk for lung cancer surgery? Maybe not
A recent headline from the Annals of Thoracic Surgery announced that high-risk patients with lung cancer might be candidates for surgery after all. But, to thoracic surgeon Jeffrey Spillane MD, this isn’t groundbreaking news.
“This study is not earth-shaking. It has been known for a while that limited resection has a role in treating lung cancer,” said Dr. Spillane.
Titled “Outcomes After Surgery in High-Risk Patients with Early Stage Lung Cancer,” investigators make the case for surgery, citing the need for alternative approaches to treatment. The study’s authors explained that lung cancer surgery is risky and can have serious complications, but it may offer the best hope for a cure.
Being over 60, with a significant smoking history and other health issues increases surgical risk. Consequently, 20 percent of patients with stage I non-small cell lung cancer are not offered surgery as a treatment option. Non-small lung cancer accounts for 85 to 90 percent of all lung cancer diagnosed.
Researchers at Emory University evaluated the effect of limited surgical resection, where part of the lung is removed, on high-risk patients with early stage non-small cell lung cancer. Their objective was to determine the role and outcome of surgical resection on this challenging population.
Researchers reviewed 490 surgical resection cases performed for stage 1 lung cancer from 2009-2013. Meeting the criteria for high risk as determined by the American College of Surgeons Oncology Group were 180 people. Compared to standard-risk patients, this population was older, had worse lung function, and had a greater number of smoking pack years.
Still The Leading Cause of Death
Lung cancer remains the leading cause of cancer-related death in the United States. Without treatment, survival for patients with non-small cell lung cancer is dismal. Determining operative risk can have a profound effect on the choice of treatments made available to patients. Taking a tailored approach ensures that all patients, regardless of their risk status, are offered the best chance for survival.
The Emory study found that there was essentially no difference in deaths while recovering in the hospital after surgery between the high risk and standard risk groups (2 percent versus 1percent.) The higher risk group did experience more post-surgical illness and on average stayed an additional day in the hospital as compared to the standard risk group. This was not a surprise, as they were sicker to begin with.
Researchers were surprised to discover that 20 percent of the high-risk surgical cases had positive lymph nodes, which were not detected in pre-surgical imaging. As a result of this finding, the affected patients were offered chemotherapy a lot earlier than they would have had they not undergone surgery.
The data also showed acceptable 1-, 2- and 3-year survival rates for the high-risk surgical cases, as compared to historically known rates for non-surgical treatments.
Since determining operative risk is an important part of forming a patient’s treatment plan, this study’s authors acknowledged the arbitrary nature of the process. But, for Dr. Spillane, it’s less about coming up with a rigid classification system and more about taking a tailored approach with each patient.