Study Reveals Probable Benefits of Surgery for High-Risk Cancer Patients

November 2015

Wanting to test the dominant notion that patients considered high-risk with early stage lung cancer should only be treated with nonsurgical therapies, Emory cardiothoracic surgeon Manu Sancheti, MD, led a study which compared clinical outcomes of patients considered to be high-risk with those of standard-risk patients after lung cancer surgery. The resulting article has been published in The Annals of Thoracic Surgery and concludes that surgical lung resection, in which part of a lung is removed, can be a safe and effective treatment option for high-risk patients with early stage lung cancer.

Previous research had suggested that high-risk patients—generally defined as aged 60 and older, long-term smokers, and having other health problems—are more likely to have complications or to die after lung surgery.

"Consequently, one in five patients with stage I non-small-cell lung cancer has been deemed inoperable or at high-risk for surgery," says Dr. Sancheti. "Our research shows these patients should not be denied surgery, because they may benefit from it."

Using Emory data from the General Thoracic Surgery Database of the Society of Thoracic Surgeons, the research team identified 490 patients who underwent surgical resection for early stage lung cancer at Emory from 2009 through 2013. Patients were classified as standard risk (310 patients) or high risk (180 patients), based on previously published criteria from the American College of Surgeons Oncology Group.

The researchers evaluated patient outcomes and survival following surgery and found that overall length of hospital stay was longer for high-risk patients (five days) compared to standard-risk patients (four days), but there was no difference among the two groups in post-operative mortality (two percent for high-risk patients; one percent for standard-risk patients).

"Importantly, we found that cancer that had spread to the lymph nodes was discovered during surgery in about 20 percent of the high-risk patients, a finding that was unexpected based on the pre-operative imaging tests," Dr. Sancheti says. "This group of patients was able to undergo chemotherapy, which is an important adjunct treatment for their cancer stage. This spread would not have been discovered and accordingly treated through a non-surgical approach."

At three years post-surgery, the researchers found that 59 percent of high-risk patients were still alive, and 76 percent of standard-risk patients had survived.

"These results clearly show that surgical resection is an acceptable treatment option for this group of patients, and that they should not be denied this treatment avenue," he says. "A multidisciplinary team should review each case to determine the best treatment plan for individual lung cancer patients."

The study was entitled "Outcomes After Surgery in High-Risk Patients With Early Stage Lung Cancer," and Dr. Sancheti's coauthors were John Melvan, MD, PhD, Rachel Medbery, MD, Felix Fernandez, MD, Theresa Gillespie, PhD, Qunna Li, MBBS, Jose Binongo, PhD, and Allan Pickens, MD. The senior author was Seth Force, MD.

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