WTSA: Outcomes in Lung Cancer Patients Initially Refused Operation

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Outcomes in Lung Cancer Patients Initially Refused Operation

David A Edelman, *Frank Baciewicz, Jr.
Wayne State University, Detroit, MI

BACKGROUND: Recent reports have proposed increased age, increased morbidity, and declining number of lung specialists for the decreased resection rate in early stage lung cancer. Our surgical population includes 21% Second Surgical Opinion (SSO) patients not offered surgical intervention after initial evaluation at other institutions. This study assesses the reasons SSO patients were initially rejected for operation at other institutions and determines the results of operative intervention in the SSO patients in comparison to patients seen initially at a large multidisciplinary cancer center.
METHODS: An analysis of 124 consecutive patients undergoing lung operation for presumed cancer by a single surgeon from June 2006 through June 2008. This included 26 patients (21%) in the SSO (Group I) and 98 patients (79%) seen initially at our cancer center (Group II). The reason for rejection in Group I patients and the results of operation in both groups were monitored.
RESULTS: Reasons for initial rejection in Group I patients were: 1) anatomically unresectable (11 patients); 2) radiologic contraindication (9 patients); 3) multiple lesions (6 patients); 4) inadequate pulmonary reserve (4 patients); 5) significant medical comorbidities (2 patients); 6) age older than 86 years (2 patients); 7) patient misunderstandings (2 patients); 8) prior high dose radiation (1 patient); 9) negative diagnostic study (1 patient); and negative exploratory thoracotomy (1 patient). Age and comorbidites were similar for both groups. Open thoracotomy was performed in 23/26 Group I patients and 76/98 Group II patients. The planned resection was completed in 25/26 Group I patients and 94/98 Group II patients. Two Group I patients (85) and nine Group II patients (9%) had positive N2 nodes. Length of stay was identical (9 days) and the single death was in a Group II patient.
CONCLUSIONS: A SSO after initial rejection for extirpation of lung cancer is highly desirable. The outcomes in these patients are comparable to patients offered resection after initial evaluation at a large multidisciplinary cancer center.

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