Lung surgery is safe in certain patients with stage IV lung cancer, a new retrospective study suggests.
"Patients with disseminated malignancy (DMa) - including primary lung cancer patients and those with pulmonary metastatic disease from other primary tumors - had equivalent rates of postoperative complications, mortality, reoperation, and discharge to nursing homes as non-DMa patients undergoing similar pulmonary resection procedures," said lead author Dr. Sarah B. Bateni of the UC Davis Medical Center in Sacramento, California.
"Surgical intervention in disseminated cancer patients is very risky and we need to carefully evaluate the risks, benefits, and goals of therapy. In selected patients, we may be able to perform surgery safely with acceptable postsurgical morbidity rates," she told Reuters Health by email.
Dr. Bateni and her colleagues identified more than 6,300 patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) who had undergone lung resections, including 603 patients with DMa.
After controlling for preoperative and intraoperative differences, the team found no significant differences in the rates of 30-day overall and serious morbidity or mortality between patients with and without DMa.
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"We were surprised by these results," senior author Dr. Robert J. Canter, also at UC Davis, told Reuters Health by email.
"This study helps us better understand the acute risk of thoracic surgery for patients with advanced cancer because lung resections are commonly performed in patients with metastatic disease to the lung and are also advocated in select patients with primary lung cancer," he said. "It is important to identify subgroups of DMa patients for whom surgical intervention may be safe and feasible."
"It is essential to recognize that this is a retrospective study where patient selection is always a critical factor," he pointed out. "However, the ACS-NSQIP database is a highly robust, carefully audited registry with very granular data on patient risk factors and post-surgical outcomes."
Unfortunately, Dr. Canter noted, the database does not contain data on outcomes such as disease progression and survival, so his research team could not consider them, and they could not analyze outcomes for patients who did not have surgery.
"We were unable to determine from our data the intent of surgical resection, whether it was disease control or palliation. This is an important question for further research since it may impact surgical complication rates, quality of life, and survival," he said.
Dr. Jessica Donington, a cardiothoracic surgeon at the New York University School of Medicine in New York City, told Reuters Health by phone, "The authors' clearly stated goal was to investigate whether the procedure was safe and they were able to prove that it was safe."
"Within the last five years or so, our view of stage IV lung cancer has changed," she said. "Prior to that time, we all thought that patients with stage IV lung cancer were clearly going to die of their disease and that most of them are going to die quickly, so putting them through operations was too much."
"As our chemotherapies have gotten better - more tolerated, directed, and personalized - the grand majority of patients with stage IV lung cancers still die of their cancer, but that may happen many years away," she added. "We still have to take care of them, and sometimes that requires surgery."
Dr. Donington said surgeons are doing more and more operations in this population, and she would like to see that trend continue.
"In general, we're choosing the patients carefully, so I'm not surprised that the short-term outcomes are very good," she said.