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European Journal of Cardio-Thoracic Surgeryejcts.oxfordjournals.org
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The European Journal of Cardio-Thoracic Surgery is the ideal place to reach cardio-thoracic surgeons in Europe and beyond. It is an international journal that accepts submissions from all regions. The journal is supported by a number of leading European societies.
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Complications following lung surgery in the Dutch–Belgianrandomized lung cancer screening trial
Susan C. van’t Westeindea,b,*, Nanda Horewegb, Paul De Leync, Harry J.M. Groend, Jan-Willem J. Lammerse,
Carla Weeninkf, Kristiaan Nackaertsc and Rob J. van Klaverena
a Department of Pulmonology, Erasmus MC Rotterdam, Rotterdam, Netherlandsb Department of Public Health, Erasmus MC Rotterdam, Rotterdam, Netherlandsc Department of Thoracic Surgery, UZ Gasthuisberg, Leuven, Belgiumd Department of Pulmonology, UMC Groningen, Groningen, Netherlandse Department of Pulmonology, UMC Utrecht, Utrecht, Netherlandsf Department of Pulmonology, Kennemer Gasthuis Haarlem, Haarlem, Netherlands
* Corresponding author. Department of Pulmonology, Erasmus MC, ’s Gravendijkwal 230, 3015 CE Rotterdam, Netherlands. Tel: +31-10-4634870;fax: +31-10-4634871; e-mail: [email protected] (S.C. van’t Westeinde).
Received 15 October 2011; received in revised form 8 January 2012; accepted 10 January 2012
Abstract
OBJECTIVES: To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who under-went 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-morbidityinto account.
METHODS: Between April 2004 and December 2008, 198 subjects underwent thoracic surgery. Co-morbid conditions were retrievedfrom 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 wereperformed. 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 com-plication (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 rangewhen 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 thosein 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.
Keywords: Postoperative complications • Thoracotomy • Thoracic surgery • Video-assisted • Early detection of cancer • Lung neoplasms
INTRODUCTION
It has been shown that lung cancer screening by low-dose multi-detector computer tomography (CT) can detect lung cancer in ahigh proportion at an early stage [1]. Before considering imple-mentation of CT screening, a reduction in lung cancer mortalityhas to be demonstrated by randomized clinical trials and thebalance between the benefits and harms of screening has to beevaluated thoroughly. Important aspects to be taken intoaccount are the effect of CT screening on health-related qualityof life, and the occurrence of complications associated with thework-up and treatment of participants with a positive test result.Patient-related factors, such as a poor general health status, age
and co-morbidity, contribute to the risk of postoperative pul-monary complications [2]. Screening populations usually consistof heavy current and former smokers at an advanced age and athigh risk for co-morbid disease. In several studies, it has beenshown that co-morbidity can predict morbidity and mortality ofsurgical procedures [3]. To be able to make a fair comparisonwith the mortality and complication data reported in non-lungcancer screening series, the co-morbidity of the screen popula-tion has to be assessed. Our objective was to assess the compli-cation rate in participants in the screen arm of theDutch-Belgian lung cancer screening trial (NELSON) who under-went a surgical resection and to investigate, based on a literaturereview, whether the complication rate, length of stay and
© The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
European Journal of Cardio-Thoracic Surgery 42 (2012) 420–429 ORIGINAL ARTICLEdoi:10.1093/ejcts/ezs081 Advance Access publication 5 April 2012
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