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N. Clayton
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-020 - Physiological Assessment in Thoracic Surgery for High Risk Patients with Lung Cancer; How Do International Guidelines Compare? (ID 1461)
09:30 - 17:00 | Author(s): N. Clayton
- Abstract
Background:
Surgical resection is the best curative option in patients with appropriately staged lung cancer. Physiological assessment is vital in selecting patients for surgical resection with particular attention to risk of mortality and morbidity with the planned surgery. This is most crucial in patients deemed high-risk. Physiological parameters employed include spirometry (FEV1%), diffusion (DLCO%), Shuttle walks, Cardiopulmonary Exercise Testing (VO2Max absolute value and %) as well as post-operative predicted values for all of these tests using segment counting to discriminate depending on the planned surgery. However, three major international guidelines exist which advocate different approaches to assessing this patient group (BTS, ERS, ACCP). We aim to assess how these guidelines compare to one another and our local practice in informing decision-making.
Methods:
Patients with operable thoracic malignancy who were candidates for surgery and had CPET were eligible for inclusion. We retrospectively analysed all patients who underwent CPET at the University Hospital of South Manchester, a tertiary Thoracic Oncology Centre, between 01/01/2013 and 31/12/2013. Physiology reports, clinical correspondence and survival databases were analysed.
Results:
96 patients fulfilled the inclusion criteria. 3 were excluded due to no available pulmonary function data. A further 17 were excluded as they were denied surgery for non-physiology reasons (patient declined surgery, metastatic disease discovered before, small cell histology, adequate resection margin impossible, severe comorbidities). The remaining 74 patients were included in the final analysis. 62/74(84%) underwent surgery (12 pneumonectomy, 3 bilobectomy, 33 lobectomy, 4 segmentectomy, 6 wedge resection, 4 futile thoracotomy due to finding unexpected advanced disease) The overall breakdown of risk classification of patients using the 3 guidelines was as follows. BTS: low-risk 27/74 (36%), medium-risk 31/74 (42%), high-risk 16/74 (22%). ACCP: low-risk 19/74 (26%), medium-risk 52/74 (70%), high-risk 3/74 (4%). ERS: low-risk 47/74 (63%), medium-risk 16/74 (22%), high-risk 11/74 (15%). Of the patients BTS guidelines classed high-risk, we operated on 8/16 (1 pneumonectomy, 3 lobectomy, 1 segmentectomy, 2 wedge resection, 1 futile thoracotomy) with 100% survival at 90 days. We did not operate on any of the 3 patients classed high-risk by ACCP guidelines. Of the patients ERS guidelines classed high-risk, we operated on 5/11 (1 pneumonectomy, 1 bilobectomy, 2 lobectomy, 1 segmentectomy) with 100% survival at 90 days. Of those classed high-risk by ACCP 2/3 would be high-risk by BTS guidelines and of those classed high risk by BTS 2/16 would be high-risk by ACCP guidelines. Of those classed high-risk by ERS 8/11 would be high-risk by BTS guidelines and of those classed high-risk by BTS 2/16 would be high-risk by ERS guidelines.
Conclusion:
From our results a lack of concordance between the three guidelines in classification of high-risk is evident. Also, with the exception of the ACCP guidelines, our local practice has shown that patients deemed high-risk for surgery were operated on (upto and including pneumonectomy) with no cases of 90-day mortality. With this in mind an appraisal of current guidelines is indicated as well as a more consistent approach worldwide to ensure that no potentially fit patients are excluded from surgical resection of lung cancer.
