[Experience of surgical treatment for primary lung cancer in Geneva 1977-1996]

In Switzerland, primary lung carcinoma is the leading cause of cancer death among males and the third cause of cancer death after carcinomas of the breast and colon in females. Surgical resection is the only potentially curative treatment but only in 20-25% of the patients.

Between January 1, 1977 and December 31, 1996, 1079 consecutive patients (877 males, 202 females) underwent surgery for primary lung carcinoma at the University Hospital of Geneva.

Lobectomy was performed in the majority of patients (n = 558, 51.7%), followed by pneumonectomy (n = 319, 29.6%), exploratory thoracotomy (n = 73, 6.8%), segmentectomy (n = 68, 6.3%), and bilobectomy (n = 61, 5.6%). Most tumours were squamous cell carcinomas (n = 613, 57%) and adenocarcinomas (n = 327, 30.3%). Small cell lung carcinomas were diagnosed in 33 patients (3%). The overall operative mortality rate was 6.6%. However, over the period studied, the operative mortality decreased from 9% in 1977-1980 to 4% in 1993-1996. Survival according to the new staging system was 61% at 5 years in stage IA, 43% in stage IB, 37% in stage IIA, 19% in stage IIB, 14% in stage IIIA, 0% in stage IIIB, and 4% in stage IV.

In future, improvement in long-term survival will require earlier detection of lung carcinomas and better adjuvant and neoadjuvant therapies for advanced tumours.