Lung cancer resection at Manmohan Cardio-Thoracic Vascular and Transplant Center—where lies our problem?

  • Thapa B, Shrestha KR, Sapkota R, Sayami P ManMohan Cardio-Thoracic Vascular and Transplant Center

Abstract

Introduction: Resection rates of Lung Cancer are low in general and in countries like ours in particular. Advanced stage at presentation and poor general condition of the patient are the usual causes.Materials and methods: In this prospective observational study, hundred cases of lung cancer who presented to the Thoracic Surgery Unit between Oct 2011 to Oct 2012 were included.Results: The 6th and 7th decades together accounted for 72/100 patients. Male to Female ratio was 2:1. There were ! ve non-smokers with mean- 29.2 ± 14.2 pack yrs smoking history. Seventy-six patients presented with locally advanced disease while 21 had metastasized. Only three had local disease. The average time between onset of symptoms to ! rst contact with a doctor was 2.3 ± 5.3 months (range: 0- 35.6 months). Average time between ! rst contact to referral was 50.432 ± 65.657 days (range- 0 – 365). Only three patients were resected, one after neo-adjuvant chemotherapy. Advanced disease was the cause of unresectability in 95 cases. One of three patients with local disease had the pulmonary functions to allow the warranted resection. N2 disease with T1-3 on CT scan was found in 47. Three of these patients underwent mediastinoscopy and all con! rmed uninvolved N2.Conclusions: Lung resection rates in our center remain low. Late presentation leading to advanced disease and poor pulmonary reserves preclude resection in most. More liberal use of mediastinal staging and better assessment of pulmonary functions may allow us to improve resection rates.Key words: Lung cancer, mediastinoscopy, pulmonary functions, resection.

References

1. Graham EA, Singer JJ. Successful removal of an entire lung for carcinoma of the bronchus. J Am Med Assoc.1933;101:1371-3.
2. Damhuis RAM, Schutte PR. Resection rates and postoperative mortality in 7,899 patients with lung cancer. Eur Respir J.1995;9: 8–11.
3. Drans! eld MT, Lock BJ, Garver RI Jr. Improving the lung cancer resection rate in the US Department of Veterans Affairs Health System. Clin Lung Cancer. 2006Jan;7(4):268-72.
4. Coleman MP, Forman D, Bryant H. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995e2007 (the International Cancer Benchmarking Partnership): an analysis of population- based cancer registry data. Lancet 2011;377:127-38.
5. Crawford SM, Sauerzapf V, Haynes R, Zhao H, Forman D, Jones AP. Social and geographical factors affecting access to treatment of lung cancer. B Jour Cancer. 2009;101:897-901.
6. Sayami P, Singh BM, Koirala B, Sharma GP. Surgery of lung cancer in Tribhuvan University Teaching Hospital. JNMA. 1997;35:182-5.
7. Ellis PM, Vandermeer R. Delays in the diagnosis of lung cancer. J Thorac Dis. 2011;3:183-8.
8. Jensen AR, Mainz J, Overgaard J. Impact of delay on diagnosis and treatment of primary lung cancer. Acta Ontol.2002;24:147–52.
9. Bozcuk H, Martin C. Does treatment delay affect
survival in non-small cell lung cancer? A retrospective analysis from a single UK centre. Lung Cancer. 2001;34:243–52.
10. Billing JS, Wells FC. Delays in the diagnosis and surgical treatment of lung cancer. Thorax.1996;51:903–6.
11. Chandra S, Mohan A, Guleria R , Singh B, Yadav P. Delays during the Diagnostic Evaluation and Treatment of Lung Cancer. Asian Paci! c J Cancer Prev. 2009;10:453-6
12. Myrdal G, Lambe M, Hillerdal G. Effect of delays on prognosis in patients with non-small cell lung cancer. Thorax. 2004;59:45–9.
13. Petty T L. Simple of! ce spirometry. Clin Chest Med. 2001;22:845–59.
14. Margolis ML, Montoya FJ, Palma WR Jr. Pulmonary function tests: comparison of 95th percentile-based and conventional criteria of normality. South Med J. 1997;90:1187–91.
15. Crapo RO, Morris AH. Pulmonary function testing: sources of error in measurement and interpretation. South Med J.1989;82:875–9.
16. Win T, Jackson A, Sharples L. Relationship between pulmonary function and lung cancer surgical outcome. Eur Respir J. 2005;25:594.Olsen GN. The evolving role of exercise testing prior to lung resection. Chest. 1989; 95:218. Kerr KM, Lamb D,Wathen CG, Walker WS, and Douglas NJ. Pathological assessment of mediastinal lymph nodes in lung cancer: implications for non-invasive mediastinal staging. Thorax.1992 May;47(5):337–41.
Published
2015-03-13
How to Cite
SAPKOTA R, SAYAMI P, Thapa B, Shrestha KR,. Lung cancer resection at Manmohan Cardio-Thoracic Vascular and Transplant Center—where lies our problem?. J Soc Surg Nep, [S.l.], v. 16, n. 1, mar. 2015. ISSN 2392-4772. Available at: <http://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=3>. Date accessed: 24 feb. 2021.
Section
Original Article