Thoracic surgery in Norway 2016 Norwegian Association for

Thoracic surgery in Norway 2016 Norwegian Association for Cardiothoracic Surgery Norwegian register for general thoracic surgery. Steinar Solberg, MD, Ph. D. Department of Thoracic and Cardiovascular Surgery Rikshospitalet, Norway steinar. solberg@rikshospitalet. no

Summary, 2016 • The number of general thoracic operations is stable – some 1500 per year. • All eight hospitals have reported their operations for 2016. • For the first year the number of thoracosopies (699) is higher than the thoracotomies (698). • The number of mediastinoscpies is very low – 22 procedures in 2016. • Surgery for lung cancer is increasing. 693 operations were reported. Of these 39 % were performed by thoracoscopic technique. • No hospital in Norway can offer robotic technique in lung cancer surgery. • All curative modalities in lung cancer treatment are increasing and some 40 % of the patients are now offered curative surgery, stereotacic radiation or chemo- radiotherapy. • Very low mortality, both 30 and 90 days after surgery for lung cancer! • Continuously increasing survival after 1, 2 and 5 years in both men and women diagnosed with lung cancer. Norwegian Association for Cardiothoracic Surgery

Number of general thoracic operations reported 1800 1568 1600 1513 1448 1361 1400 1328 1325 2009 2010 1561 1478 1463 2014 2015 1265 1200 1000 800 600 400 2007 2008 2011 2012 2013 Norwegian Association for Cardiothoracic Surgery 2016

Number of operations per hospital per year 450 400 350 326 300 291 279 2012 239 250 230 2013 2014 200 2015 150 2016 90 100 61 45 50 0 Rikshosp Ullevål AHUS Tr. Heim Haukeland Tromsø Stavanger Norwegian Association for Cardiothoracic Surgery Bodø

Accesses used 1000 900 800 699 698 700 2011 600 2012 2013 500 2014 400 2015 300 2016 200 100 31 22 s no St er os in M ed ia st to pi co op os c ac Th or m ie s ie to m or ac o Th es 0 Norwegian Association for Cardiothoracic Surgery

Underlying diagnoses 800 737 700 600 500 2013 400 2014 300 2015 2016 200 160 155 125 100 62 62 53 72 56 35 20 13 Norwegian Association for Cardiothoracic Surgery er O th S TO ju ry In D ef or m iti ee ct io n (d se In fe di g un. l In t es p) e as or tu m gn ni ta er nc U Be in as ta tu m se or s in g sh /f lu in g ea t M et ax or ot h m Sw Pn eu M al . T um or 0

Organ operated upon 1200 1085 1000 800 2012 600 2013 2014 400 2015 2016 211 200 80 69 65 41 6 1 Norwegian Association for Cardiothoracic Surgery ac he a Tr r tu Th . a pp er ym Th tis ve us e su ra eu er he s C Pl N M ed ia st in tw al l um Lu ng 0

Selected operations performed 140 120 102 99 100 99 80 2013 63 2014 60 2015 44 36 40 2016 28 20 20 8 . t pr O Norwegian Association for Cardiothoracic Surgery a st co 1. es. R Th id ou ts um or ym e ec t lu om y ng n ca ec or ti D r. or C tio . w al Th ct Sy m pa te ec le ur /p R ub bi ng l om y y to m om y ct lle Bu D ia g. /B io ps y 0

Number of operations for lung metastases performed annually 200 187 185 184 180 166 156 160 140 168 154 145 139 130 120 100 80 60 40 2007 2008 2009 2010 2011 2012 2013 2014 Norwegian Association for Cardiothoracic Surgery 2015 2016

Operations for lung cancer 800 693 700 604 600 503 626 590 601 599 2013 2014 521 490 500 450 400 300 200 100 0 2007 2008 2009 2010 2011 2012 Norwegian Association for Cardiothoracic Surgery 2015 2016

Number of operations for lung cancer per hospital per year 160 151 140 132 120 114 113 2012 100 2013 83 2014 80 2015 60 2016 46 40 32 22 20 Norwegian Association for Cardiothoracic Surgery dø Bo ge r an av St Tr om sø nd ke au H Tr H la ei m S U AH lle vå l U R ik sh os p 0

Prosedures performed in operations for lung cancer 600 559 500 400 2012 2013 300 2014 2015 2016 200 100 44 42 40 10 6 0 Only exploration Pneumonectomy Bi-lobectomy Lobectomy Sub-lobar res Norwegian Association for Cardiothoracic Surgery Bronchoplasty

From the Cancer Registry of Norway, 2016 The percentage of resections for lung cancer performed by thoracoscopy (VATS)

The number (columns) and percentage (line) of operations for lung cancer performed by VATS / thoracoscopic lobectomies 300 45 271 40 39 250 35 200 185 151 30 25 Number VATS operations 150 Percentage. VATS operations 20 101 100 15 49 50 50 5 6 9 18 5 0 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 0 10 Norwegian Association for Cardiothoracic Surgery

The percentage of patiens beeing females in surgery for lung cancer 400 60 350 50 48 300 40 250 Males Number opoerations 200 30 Percentage females Females % females 150 20 10 50 0 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 Norwegian Association for Cardiothoracic Surgery 2016

Median (min – max) age for patients operated for lung cancer 2011 - 2015 2012 2013 2014 2015 2016 Females 66 (19 -87) 67 (30 -85) 67 (8 -85) 68 (36 -86) 69 (19 -84) Males 67 (20 -84) 69 (37 -85) 69 (43 -86) 69 (31 -89) 69 (9 -86) Norwegian Association for Cardiothoracic Surgery

The age distribution in 6852 patients operated for lung cancer 2003 - 2016 Norwegian Association for Cardiothoracic Surgery

The number (columns) and percentage (line) of patients operated for lung cancer beeing 80 years or older 40 6 35 5 30 Number operations 4. 3 4 25 25 Percentage 20 3 15 2 10 1 5 0 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Norwegian Association for Cardiothoracic Surgery

Location of tumor in 6190 operations for lung cancer 2003 -2016 1960 (32 %) 1620 (26 %) 375 (6 %) 1207 (19 %) 3542 (57 %) 1028 (17 %) 2648 (43 %)

Improved survival after 1, 2 and 5 years in the whole group of lung cancer patients. The Cancer Registry of Norway http: //www. kreftregisteret. no/ Norwegian Association for Cardiothoracic Surgery

From the Cancer Registry of Norway, 2016 The stage distribution, based on p. TNM for the patients operated for lung cancer

From the Cancer Registry of Norway, 2016 The percentage of the patients operated, with c. N 2 – known spread of cancer to one or more regional lymph node(s) before surgery.

From the Cancer Registry of Norway, 2016 The percentage of the patients diagnosed with lung cancer that has been operated.

From the Cancer Registry of Norway, 2016* The percentage of the patients diagnosed with lung cancer that has been treated with intention to cure – eg: • Surgery: 21% • Stereotactic radiation: 8 % • Chemo-radiation: 8% • TOTAL: 37 % !! *The figures given are from 2015.

From the Cancer Registry of Norway, 2016 30 days mortality after surgery for lung cancer

From the Cancer Registry of Norway, 2016 90 days mortality after surgery for lung cancer

TAKK