Norwegian Association for Cardiothoracic Surgery
Norwegian register for general thoracic surgery.
Steinar Solberg, MD, PhD.
Department of Cardiothoracic Surgery
Thoracic surgery in Norway 2018
Summary, 2018
•
A high number – 750 operations for lung cancer are reported.
•
First time in Norway:
– Females outnumber the males in surgery for lung cancer (53 %).
– A Robot Assisted lobectomy for lung cancer was done at AHUS 17th December.
•
The proportion of thoracoscopic lung cancer operations decreased for the first time.
•
The number of operations for malignant tumour is increasing.
•
The number of operations for lung metastases is reduced.
•
There has been a slight reduction of most other procedures than for malignant tumour.
•
Two hospitals have a low number lung cancer operations.
Norwegian Association for Cardiothoracic Surgery
• Very low mortality after surgery for lung cancer.
– 30 days mortality: 1.0 % – 90 days mortality: 2,1 %
• A continuous increase, to 23,0 %, in the proportion of lung cancer patients operated.
• The proportion of thoracoscopic lung cancer operations varies from 0,0 % to 75 % among the hospitals.
• The 1 year relative survival in those operated is high and varies from 82,1 % to 99,3% in the hospitals.
• A very high proportion of the operations is reported, but too many come very late.
• Four hospitals have a low proportion of the lung cancer operations performed by thoracoscopy (VATS).
Synopsis from The Cancer Registry of Norway, 2018
Trends in diagnosis, treatment and outcome for lung cancer in Norway
The Cancer Registry of Norway
2001 2016
New cases of lung cancer Females 795 1527
Males 1347 1678
Incidence, age-standardized rates, Norway, 2014 per 100 000 per year Total 50.6 59.5
Females 35.4 53.8
Males 71.5 67.9
Mean age (years) at diagnosis Females 67.3 70.7
Males 69.4 71.3
Proportion small cell lung cancer (%) Females 19.9 15.3
Males 15.1 13.1
Stage distribution (%)
Localized Females 11.2 19.7
Males 13.2 16.3
Metastatic Females 52.8 38.3
Males 47.4 37.1
Median survival all patients (monts) 6.0 11.8
Relative survival all pts. (per cent, 5-year) 9.4 19.9
Number of general thoracic operations reported
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 200 400 600 800 1000 1200 1400 1600 1800
1328 1325
1568
1448
1513 1478 1463
1561
1633
1530
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
342
262
164
240
302
78
0
61
81
2014 2015 2016 2017 2018
*
*
No operations reported for 2018Accesses used
Thoracotomies
Thoracoscopies
Mediastinoscopies
Sternotomies
Robot 0
100 200 300 400 500 600 700 800 900
649
764
22 44
1
2014 2015 2016 2017 2018
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
803
127
53
123
53 60
17
48
106
13 3
119
2014 2015 2016 2017 2018
Organ operated upon
Lung
Mediastinum
Chest wall
Pleura
Nerve tissue
Thymus
Th. appertur
Trachea 0
200 400 600 800 1000 1200
1093
59
179
83 54 52
3 4
2014 2015 2016 2017 2018
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
66
117
2
53
83
21
40
50
3
2014 2015 2016 2017 2018
Number of operations for lung metastases performed annually
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 20 40 60 80 100 120 140 160 180 200
139
156
187 184
166 168
154
146
167
115
Norwegian Association for Cardiothoracic Surgery Operations for lung cancer
*
The Cancer Registry has registerted 729 operations in 20182009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 100 200 300 400 500 600 700 800
521
490
604 590 601 599
626
692 703
750
*
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
154
161
71
144
136
44
0
40
18
2014 2015 2016 2017 2018
*
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
7
48 53
585
49
10
2014 2015 2016 2017 2018
The number (bars) and percentage (line) of lobectomies for lung cancer completed by VATS
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 50 100 150 200 250 300 350
0 5 10 15 20 25 30 35 40 45 50
9
18
49 50
101
151
185
271
326 327
44
Nu mb er
VA TS
op er at oi ns
Pe rc en ta eg VA TS
op er at oi ns
From the Cancer
Registry of Norway, 2018
Figure 3.16
The percentage of resections
for lung cancer performed by
thoracoscopy (VATS)
The percentage of patiens beeing females in surgery for lung cancer
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 50 100 150 200 250 300 350 400 450
0 10 20 30 40 50 60
53
Males Females
% females Nu
mb er
op er at oi ns
Pe rc en ta eg
ef ma el s
Age – quartiles for those operated for lung cancer Data extracted from 6102 operations
Norwegian Association for Cardiothoracic Surgery
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
55 57 59 61 63 65 67 69 71 73 75
74 73
70 69
64 63
Males 75 % Females 75 % Males 50 (median) Females 50 (median) Males 25 %
Females 25 % Ag
e - ey ar s
The number (bars) and percentage (line) of patients operated for lung cancer being 80 years or older
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0 5 10 15 20 25 30 35 40 45
0 1 2 3 4 5 6 5.6
Number operations
Percentage
Nu mb er of op er at oi n
Pe rc ne at ge
Norwegian Association for Cardiothoracic Surgery
http://www.kreftregisteret.no/
The Cancer Registry of Norway
Figure 3.26
Survival – up to 12 months for patients diagnosed with lung cancer 2016 – 2018.
Stages I, II, III and IV.
Figure 1.1
The indicators for quality for the treatment and the reporting to The Cancer Registry.
From The Cancer Registry of Norway, 2018
From The Cancer Registry of Norway, 2018
Figure 5.4
The proportion of the
operations that are reported to
The Registry, and the median
time (in days) from surgery to
reporting.
From The Cancer Registry of Norway, 2018
Figure 3.14 The “flow” for patients operated for lung cancer in 2018. From left: the 1-year relative survival for all patients with lung cancer in the respective hospital areas, the proportion operated, the flow from local
Figure 3.14
The proportion of the patients operated within the first two weeks after decision.
From The Cancer Registry of Norway, 2018
10 12 14 16 18 20 22 24
16.2
23.0
Per cent of those diagnosed that have been operated for lung cancer Data from The Cancer Registry of Norway
Pe r ec nt
Figure 3.12
The proportion of the patients given curative treatmet – surgery,
stereotactic radiation or fractionated radiotherapy.
From The Cancer
Registry of Norway, 2018*
*Wide bars 2018, tiny bars 2017.
Figure 3.17. 30 days mortality after surgery for lung cancer
From The Cancer
Registry of Norway, 2018
Figure 3.18. 90 days mortality after surgery for lung cancer
From The Cancer
Registry of Norway, 2018
The outcome for patients with metatases is still poor,
however, for a subgroup there has been an increased survival
Figure 3.24
Survival for 25, 50 and 75 percentile of patients with metastatic lung cancer
Norwegian Association for Cardiothoracic Surgery Papers presenting lung cancer in Norway