Thirty-day mortality and five-year survival in thoracic surgery: "real-world" assessment of outcomes from a single-institution audit

Anna Cantarutti, Carlotta Galeone, Giovanni Leuzzi, Elena Bertocchi, Giovanna Pomponi, Martin Langer, Vincenzo Mazzaferro, Gustavo Galmozzi, Giovanni Apolone, Giovanni Corrao, Ugo Pastorino

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Accurate measurement of outcomes is essential to monitor the effectiveness of public health policies. In Italy, the Ministry of Health has chosen 30-day mortality after major surgical or medical procedures as the main outcome measure, pooling all pulmonary resections for malignancy in a single category. The present audit evaluated all pulmonary resections performed over a 13-year period in a single institution to assess the immediate (30-day mortality) and long-term (5-year survival) outcomes according to type and stage of disease and extent of surgery.

METHODS: We analyzed the results of 4,234 first pulmonary resections performed from 2003 to 2015 for lung cancer (2,636), lung metastases (1,080), other primary cancers (259) and benign diseases (259). The median follow-up of cancer patients was 4.1 years.

RESULTS: Overall 30-day mortality was 1.1%, being 1.2% for lung cancer, 0.3% for lung metastases, 3.5% for pneumonectomies, 1% for lobectomies, and 0.5% for sublobar resections. Among lung cancer patients, 30-day mortality was 0.7% for simple anatomical resections, 2.8% for complex resections, 0.7% for stage I, and 1.6% for higher stages. Overall 5-year survival was 56% for lung cancer, 49% for lung metastases, and 53% for other primary cancers (p = 0.03). According to the surgical procedure for lung cancer, 5-year survival was 60%, 55% and 36% for lobectomies, segmentectomies and pneumonectomies, respectively (p<0.0001).

CONCLUSIONS: For better monitoring of thoracic surgery outcomes in a real-world setting, we suggest evaluating lung cancer separately from other thoracic malignancies, and including 5-year survival rates stratified by resection volume and surgical procedure complexity.

Original languageEnglish
Pages (from-to)96-104
Number of pages9
JournalTumori
Volume104
Issue number2
DOIs
Publication statusPublished - Dec 2 2017

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Thoracic Surgery
Lung Neoplasms
Outcome Assessment (Health Care)
Survival
Mortality
Lung
Pneumonectomy
Neoplasms
Neoplasm Metastasis
Segmental Mastectomy
Public Policy
Health Policy
Italy
Thorax
Survival Rate
Public Health
Health

Keywords

  • Female
  • Humans
  • Italy
  • Lung Neoplasms/mortality
  • Male
  • Middle Aged
  • Neoplasm Staging/methods
  • Pneumonectomy/methods
  • Survival Rate
  • Thoracic Surgery/methods
  • Treatment Outcome

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Thirty-day mortality and five-year survival in thoracic surgery: "real-world" assessment of outcomes from a single-institution audit. / Cantarutti, Anna; Galeone, Carlotta; Leuzzi, Giovanni; Bertocchi, Elena; Pomponi, Giovanna; Langer, Martin; Mazzaferro, Vincenzo; Galmozzi, Gustavo; Apolone, Giovanni; Corrao, Giovanni; Pastorino, Ugo.

In: Tumori, Vol. 104, No. 2, 02.12.2017, p. 96-104.

Research output: Contribution to journalArticle

Cantarutti, Anna ; Galeone, Carlotta ; Leuzzi, Giovanni ; Bertocchi, Elena ; Pomponi, Giovanna ; Langer, Martin ; Mazzaferro, Vincenzo ; Galmozzi, Gustavo ; Apolone, Giovanni ; Corrao, Giovanni ; Pastorino, Ugo. / Thirty-day mortality and five-year survival in thoracic surgery: "real-world" assessment of outcomes from a single-institution audit. In: Tumori. 2017 ; Vol. 104, No. 2. pp. 96-104.
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AU - Bertocchi, Elena

AU - Pomponi, Giovanna

AU - Langer, Martin

AU - Mazzaferro, Vincenzo

AU - Galmozzi, Gustavo

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AB - BACKGROUND: Accurate measurement of outcomes is essential to monitor the effectiveness of public health policies. In Italy, the Ministry of Health has chosen 30-day mortality after major surgical or medical procedures as the main outcome measure, pooling all pulmonary resections for malignancy in a single category. The present audit evaluated all pulmonary resections performed over a 13-year period in a single institution to assess the immediate (30-day mortality) and long-term (5-year survival) outcomes according to type and stage of disease and extent of surgery.METHODS: We analyzed the results of 4,234 first pulmonary resections performed from 2003 to 2015 for lung cancer (2,636), lung metastases (1,080), other primary cancers (259) and benign diseases (259). The median follow-up of cancer patients was 4.1 years.RESULTS: Overall 30-day mortality was 1.1%, being 1.2% for lung cancer, 0.3% for lung metastases, 3.5% for pneumonectomies, 1% for lobectomies, and 0.5% for sublobar resections. Among lung cancer patients, 30-day mortality was 0.7% for simple anatomical resections, 2.8% for complex resections, 0.7% for stage I, and 1.6% for higher stages. Overall 5-year survival was 56% for lung cancer, 49% for lung metastases, and 53% for other primary cancers (p = 0.03). According to the surgical procedure for lung cancer, 5-year survival was 60%, 55% and 36% for lobectomies, segmentectomies and pneumonectomies, respectively (p<0.0001).CONCLUSIONS: For better monitoring of thoracic surgery outcomes in a real-world setting, we suggest evaluating lung cancer separately from other thoracic malignancies, and including 5-year survival rates stratified by resection volume and surgical procedure complexity.

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