Resection safe and helpful for high-risk, early-stage lung cancer patients

by Bruce Sylvester: Surgical resection is a safe and helpful treatment option for a broad range of patients with early-stage lung cancer, researchers reported online on  Nov. 10, 2015 in the Annals of Thoracic Surgery.

Manu Sancheti, MD, assistant professor of medicine at Emory University in Atlanta, Georgia, and  colleagues noted that prior research indicated that most patients with lung cancer who might be candidates for pulmonary resection are over 60, have a smoking history and other conditions like lung disease or heart disease. “Consequently, one in five patients with stage I non-small-cell lung cancer is deemed inoperable or at high-risk for surgery,” said Dr. Sancheti. “Our research shows these patients should not be denied surgery, because they may benefit from it.”

In their retrospective analysis, the researchers identified 490 patients who had undergone surgical resection for early stage lung cancer at Emory from 2009 through 2013.  They classified the subjects as standard risk (310 patients) or high risk (180 patients), using criteria developed by the American College of Surgery Oncology Group.

Evaluating outcomes and survival after surgery, they found that overall length of hospital stay was slightly longer for high-risk patients, 5 days, compared to standard-risk patients, 4 days. However, they found no significant difference between the groups for post-operative mortality, 2% for high-risk patients and 1% for standard-risk patients.

“Importantly, we found that about 20% of our patients had cancer that had spread to their lymph nodes, a finding that was unexpected based on the pre-operative imaging tests,” said Sancheti. “This group of patients was able to undergo chemotherapy, which is an important adjunct treatment for their cancer stage. This spread of cancer to the lymph nodes would not have been discovered and accordingly treated through a non-surgical approach.”

At 3-years post-surgery, the researchers found that 59% of high-risk patients and 76% of standard-risk patients had survived.

“Our results show that surgical resection is an acceptable treatment option with good results for patients with early stage lung cancer who have been identified as high-risk for surgery,” said Sancheti. “High-risk patients have a new treatment avenue that previously may have been denied to them. A multidisciplinary team should review each case to determine the best treatment plan for individual lung cancer patients.”