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• W4240306517 abstract "As two Seminars in this week's issue show, surgery has an important part to play in the management of early-stage lung cancer. Surgical lung resection offers good rates of cure for patients who have stage I or II non-small-cell lung cancer and immediate surgery is beneficial for those with small-cell lung cancer with very limited stage disease. In the past, the UK's surgical resection rates have remained lower than those achieved in Europe and the USA, but a new audit suggests that this situation is changing. The UK's second National Thoracic Surgery Activity and Outcomes Report shows that the number of patients with lung cancer undergoing surgery has increased by 60% in the past 4 years, while post operative mortality has halved during the past decade from 3·8% to 2·1%. This improvement has been due in part to thoracic surgery becoming more defined as a specialty (as opposed to cardiothoracic surgery), resulting in an increase in surgeons in this area. However, there is still a need to boost numbers. The audit notes that, if the rate of operations across the country matched the best performing areas, then at least an additional 1000 lives could be saved each year. Furthermore, current evidence supports the expansion of surgery as part of multimodality management of patients with N2 disease (metastasis in ipsilateral mediastinal or subcarinal lymph nodes or both), and, as diagnostic techniques improve, more cancers will be detected at an operable stage. Training in new surgical techniques also needs attention. Technical advances have led to the development of lung resection with video-assisted thoracoscopic access (VATS lung resection). In their Seminar on non-small-cell lung cancer, Peter Goldstraw and colleagues report no difference in mortality or local recurrence between open resections or VATS, but lower systemic recurrences and improved 5-year survival with VATS. The current balance of risks and benefits suggest that VATS might be a viable option for selected patients with early-stage lung cancer. Yet the national audit shows that only 35% of operations are done with VATS. Further development of thoracic surgery as a specialty should be encouraged to improve the management of lung cancer in the future. Non-small-cell lung cancerIn the decade since the last Lancet Seminar on lung cancer there have been advances in many aspects of the classification, diagnosis, and treatment of non-small-cell lung cancer (NSCLC). An international panel of experts has been brought together to focus on changes in the epidemiology and pathological classification of NSCLC, the role of CT screening and other techniques that could allow earlier diagnosis and more effective treatment of the disease, and the recently introduced seventh edition of the TNM classification and its relation to other prognostic factors such as biological markers. Full-Text PDF Small-cell lung cancerThe incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. Patients often present with rapid-onset symptoms due to local intrathoracic tumour growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. Full-Text PDF" @default.
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• W4240306517 date "2011-11-01" @default.
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• W4240306517 title "Improving rates of surgery for lung cancer" @default.
• W4240306517 doi "https://doi.org/10.1016/s0140-6736(11)61724-8" @default.
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