Complications following lung surgery in the Dutch-Belgian randomized lung cancer screening trial

• Published in: European journal of cardio-thoracic surgery 2012-09, Vol.42 (3), p.420-429
• Main Authors: van't Westeinde, Susan C., Horeweg, Nanda, De Leyn, Paul, Groen, Harry J.M., Lammers, Jan-Willem J., Weenink, Carla, Nackaerts, Kristiaan, van Klaveren, Rob J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cause of Death; Chi-Square Distribution; Confidence Intervals; Disease-Free Survival; Early Detection of Cancer - methods; Female; Humans; Linear Models; Lung Neoplasms - diagnosis; Lung Neoplasms - epidemiology; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Multidetector Computed Tomography - methods; Neoplasm Invasiveness - pathology; Neoplasm Staging; Netherlands; Pneumology; Pneumonectomy - methods; Pneumonectomy - mortality; Positron-Emission Tomography - methods; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Prognosis; Reoperation - methods; Reoperation - mortality; Risk Assessment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - methods; Thoracotomy - adverse effects; Thoracotomy - methods; Treatment Outcome; Tumors of the respiratory system and mediastinum
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezs081

OBJECTIVES To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital stay, re-thoracotomy and mortality rates after a surgical procedure were different from those of the non-screening series, taking co-morbidity into account. METHODS Between April 2004 and December 2008, 198 subjects underwent thoracic surgery. Co-morbid conditions were retrieved from the medical records. Postoperative complications were classified as minor and major. RESULTS In total, 182 thoracotomies, 5 thoracotomies after video-assisted thoracoscopic surgery (VATS) and 11 VATS procedures were performed. In these patients, 36% had chronic obstructive lung disease, 16% coronary artery disease, 14% diabetes mellitus and 11% peripheral vascular disease. Following thoracotomy, 47% (88/187) had ≥1 minor (7-57% in literature) and 10% (18/187) ≥1 major complication (2-26% in literature); following VATS, 38% (6/16) had ≥1 minor complication, but no major complications. Seventeen per cent (3/18) of major complications and 21% (20/96) of minor complications were seen in subjects operated for benign disease. The re-thoracotomy rate was 3% and there was no 30-day mortality after thoracotomy or VATS (0-8.3% in literature). The mortality rate of 0% after surgical procedures is low when compared with the non-screening series (0-8.3%); the rate of complications (53%) is within range when compared with the non-screening series (8.5-58%). CONCLUSIONS In conclusion, mortality rates after surgical procedures are lower in the NELSON lung cancer screening trial than those in the non-screening series. The rate of complications is within the same range as in the non-screening series. Trial registration number: ISR CTN 63545820.