Potentially curable lung cancer patients not offered operation

Recent reports have noted the decreased resection rate in early stage lung cancer. Our surgical population includes 25% second surgical opinion (SSO) patients not offered surgical intervention after initial evaluation at other institutions. This study assesses the reasons those patients were initially rejected for operation at other institutions and determines the outcome of operative intervention.

This report is an analysis of 103 consecutive patients undergoing lung operation for cancer by a single surgeon from June 2006 through June 2008. This included 26 patients (25%) in the SSO group and 77 patients (75%) seen initially at our cancer center (control).

Reasons for initial rejection in the SSO group were the following: (1) anatomically unresectable (14 patients); (2) radiologic contraindication (11 patients); (3) multiple lesions (6 patients); (4) inadequate pulmonary reserve (5 patients); (5) significant medical comorbidities (2 patients); (6) advanced age (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 comorbidities were similar for both groups. The planned resection was completed in 25 of 26 patients. Two SSO patients (8%) and nine control patients (11%) had positive N2 nodes. Length of stay was identical and the single death was in a control patient.

An SSO after initial rejection for resection of lung cancer is highly desirable. The short-term outcomes in these SSO patients screened at a multidisciplinary lung cancer center are comparable with patients offered resection after initial evaluation at a large multidisciplinary cancer center.