Norwegian Association for Cardiothoracic Surgery
Norwegian register for general thoracic surgery.
Steinar Solberg, MD, PhD.
Department of Cardiothoracic Surgery
Thoracic surgery in Norway 2019
Summary, 2019
• A high number – total 1562 operations and 748 operations for lung cancer are reported.
• A higher proportion of females (34.8 %) than males (28.1 %) are operated by thoracoscopy for lung cancer (p=0.000).
• The proportion of lung cancer operations has increased steadily from 37.0 % in 2010 to 47.9 % of the total numbers of operations in 2019.
• The female predominance in surgery for lung cancer increased from 53 % in 2018 to 56 % in 2019.
• Robotic surgery is offered at AHUS, Haukeland and in Tromsø.
• Two hospitals have a low number lung cancer operations.
Norwegian Association for Cardiothoracic Surgery
• Outstandingly low mortality in surgery for lung cancer.
– 30 days mortality: 0.6 % (four deaths in 718 operations)
• A high proportion (22 %) of lung cancer patients are operated. In addition 7 % are treated with
stereotactic radiation and 8 % with fractioned radiation. Thus 37 % are treated with intention to cure.
• In surgery, 49.5 % are operated by minimally invasive technique (thoracoscopy or robot). This varies from 0 to 85.7 % between the hospitals. Three hospitals has a too low (< 40 %) proportion of the operations performed mini invasively.
• The 5 year relative survival in those operated is high (65.0 %) and varies from 57.8 % to 72.2 % between the hospitals.
• Practically all (99.9 %) of the operations are reported, but in too many hospitals the reports are send very late – up to median 286 days after surgery. Such delay may jeopardise the quality of the data.
• The removal of lymph nodes in surgery is disappointingly low.
Synopsis from The Cancer Registry of Norway, 2019
The quality of lung cancer surgery is very high.
Though, some improvements may be suggested:
– Three hospitals should increase the use of minimally invasive technique.
– The time from surgery to reporting to The Cancer Registry should be reduced markedly by several hospitals.
– More lymph node stations should be operated out.
– All hospitals should meet the criteria set by the national health authorities.
Norwegian Association for Cardiothoracic Surgery
Number of general thoracic operations reported
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
0 200 400 600 800 1000 1200 1400 1600 1800
1325
1568
1448
1513 1478 1463
1561
1633
1566 1562
Norwegian Association for Cardiothoracic Surgery
Number of operations per hospital per year
Rikshosp Ullevål AHUS TrHeim Haukeland Tromsø Stavanger Bodø Kalnes 0
50 100 150 200 250 300 350 400 450
300
270
201
239
300
78
32
75 67
2015 2016 2017 2018 2019
Accesses used
Thoracotomies
Thoracoscopies
Mediastinoscopies
Sternotomies
Robot 0
100 200 300 400 500 600 700 800 900
Thoracotomies; 649
Thoracoscopies; 764
Mediastinoscopies; 22 Sternotomies; 44
1 574
759
17 29 51
2015 2016 2017 2018 2019
Norwegian Association for Cardiothoracic Surgery Underlying diagnoses
Mal. Tumor
Pneumothorax
Sweating / fushing
Metastases
Uncertain tumor
Benign tumor
Int. lung disease
Infection (deep)
Deformities
Injury TOS
Other 0
100 200 300 400 500 600 700 800 900
797
118
40
149
38
70
25
62
137
31 11
84
2015 2016 2017 2018 2019
Organ operated upon
Lung
Mediastinum
Chest wall
Pleura
Nerve tissue
Thymus
Th. appertur
Trachea 0
200 400 600 800 1000 1200
1092
73
218
65 41 45
16 3
2015 2016 2017 2018 2019
Norwegian Association for Cardiothoracic Surgery Selected operations performed
Diag. / Biopsy
Bullectomy
Rubbing / pleurectomy
Sympatectomy
Corr. Th.wall
Decortication
Opr. tumor outside lung
Thymectomy
Res. 1. costa 0
20 40 60 80 100 120 140
68
103
7
40
84
29
40
58
13
2015 2016 2017 2018 2019
Number of operations for lung metastases performed annually
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
0 20 40 60 80 100 120 140 160 180 200
156
187 184
166 168
154
146
167
118
134
Norwegian Association for Cardiothoracic Surgery Operations for lung cancer
*
The Cancer Registry has registerted 718 operations in 20192010 2011 2012 2013 2014 2015 2016 2017 2018 2019
0 100 200 300 400 500 600 700 800
490
604 590 601 599
626
692 703
750 748
*
Number of operations for lung cancer per hospital per year
Rikshosp
Ullevål
AHUS
TrHeim
Haukeland
Tromsø
Stavanger
Bodø 0
20 40 60 80 100 120 140 160 180
130
169
82
138 139
51
15
29
2015 2016 2017 2018 2019
Norwegian Association for Cardiothoracic Surgery Prosedures performed in operations for lung cancer
Only exploration
Pneumonectomy
Bi-lobectomy
Lobectomy
Sub-lobar res
Bronchoplasty 0
100 200 300 400 500 600 700
11 26 33
613
59
18
2015 2016 2017 2018 2019
The number (bars) and percentage (line) of operations for lung cancer performed by VATS or RATS (robot)
43 operations performed by RATS in 2019
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
0 50 100 150 200 250 300 350 400
0 10 20 30 40 50 60
9 18
49 50
101
151
185
271
326 327
358
Nu mb er
VA TS
op er at oi ns
Pe rc en t VA TS
pl us RA TS
Norwegian Association for Cardiothoracic Surgery
Operations for lung cancer performed by robot
Rikshosp Ullevål AHUS TrHeim Haukeland Tromsø Stavanger Bodø
0 5 10 15 20 25 30 35
0 0
30
0
9
4
0 0
1
2018 2019 Nu
mb er of
op er at oi ns
From the Cancer
Registry of Norway, 2019
Figure 3.13
The percentage of resections
for lung cancer performed by
thoracoscopy (VATS) and by
Robot assisted thoracic surgery
(RATS)
Norwegian Association for Cardiothoracic Surgery The percentage of patiens beeing females
in surgery for lung cancer
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
0 50 100 150 200 250 300 350 400 450
0 10 20 30 40 50 60 56
Males Females
% females Nu
mb er
op er at oi ns
Pe rc en ta eg
ef ma el s
Per cent operated for lung cancer by thoracoscopy 2010 - 2019 (n=6377)
Norway Tromsø Bodø TrHeim Haukland Stavanger RH Ullevål AHUS
0 10 20 30 40 50 60
34.8
28.1 Females
Males Pe
r ec nt
*
Difference between the sexes: p = 0.000 (Pearson chi2)*
Norwegian Association for Cardiothoracic Surgery The number (bars) and percentage (line) of patients
operated for lung cancer being 80 years or older
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
0 5 10 15 20 25 30 35 40 45
0 1 2 3 4 5 6
4.9
Number op- erations
Percentage
Nu mb er of op er at oi n
Pe rc ne at ge
The number of operation for lung cancer as proportion of the total number of operations in general thoracic surgery
1 2 3 4 5 6 7 8 9 10
0 200 400 600 800 1000 1200 1400 1600 1800
0 10 20 30 40 50 60
Total number operations Operations for lung cancer Per cent lung cancer operation Axis Title
Number operations Per cent operations for lung cancer
http://www.kreftregisteret.no/
The Cancer Registry of Norway
Figure 3.15
Five year relative survival
after surgery 2015-2019.
Figure 1.1
The indicators for quality for the treatment and the reporting to The Cancer Registry.
From The Cancer Registry of Norway, 2019
Figure 3.19
One and five year relative survival for all
patients diagnosed with lung cancer per year.
From The Cancer Registry of Norway, 2019
Figure 3.20
The median survival (in months) for all patients
From The Cancer Registry of Norway, 2019
From The Cancer Registry of Norway, 2019
Figure 5.4
The proportion of the operations that are
reported and the median time (in days) from
surgery to reporting.
From The Cancer Registry of Norway, 2019
Figure 1.2 The “flow” for patients operated for lung cancer in 2019. From left: the 1-year relative survival for all patients with
Figure 3.12
The mean number of lymph nodes reported removed in
surgery – either by «biopsy from nodes», «removal of hole lumph nodes» og by «complete removal of lymph node stations».
From The Cancer
Registry of Norway, 2019
Figure 3.9
The proportion of the patients given curative treatmet –
surgery, stereotactic radiation or fractionated radiotherapy.
From The Cancer
Registry of Norway, 2019
Figure 3.14.
30 days mortality after surgery for lung cancer
From The Cancer
Registry of Norway, 2019
