Thoracic surgery in Norway 2018 Norwegian Association for

Thoracic surgery in Norway 2018 Norwegian Association for Cardiothoracic Surgery Norwegian register for general thoracic surgery. Steinar Solberg, MD, Ph. D. Department of Cardiothoracic Surgery Rikshospitalet, Norway ssolber@online. no

Summary, 2018 • A high number – 750 operations for lung cancer are reported. • First time in Norway: – Females outnumber the males in surgery for lung cancer (53 %). – A Robot Assisted lobectomy for lung cancer was done at AHUS 17 th December. • The proportion of thoracoscopic lung cancer operations decreased for the first time. • The number of operations for malignant tumour is increasing. • The number of operations for lung metastases is reduced. • There has been a slight reduction of most other procedures than for malignant tumour. • Two hospitals have a low number lung cancer operations. Norwegian Association for Cardiothoracic Surgery

Synopsis from The Cancer Registry of Norway, 2018 • Very low mortality after surgery for lung cancer. – 30 days mortality: 1. 0 % – 90 days mortality: 2, 1 % • A continuous increase, to 23, 0 %, in the proportion of lung cancer patients operated. • The proportion of thoracoscopic lung cancer operations varies from 0, 0 % to 75 % among the hospitals. • The 1 year relative survival in those operated is high and varies from 82, 1 % to 99, 3% in the hospitals. • A very high proportion of the operations is reported, but too many come very late. • Four hospitals have a low proportion of the lung cancer operations performed by thoracoscopy (VATS).

Trends in diagnosis, treatment and outcome for lung cancer in Norway New cases of lung cancer Females Males 2001 795 1347 Incidence, age-standardized rates, Norway, 2014 per 100 000 per year Total Females Males 50. 6 35. 4 71. 5 59. 5 53. 8 67. 9 Mean age (years) at diagnosis Females Males 67. 3 69. 4 70. 7 71. 3 Proportion small cell lung cancer (%) Females Males 19. 9 15. 1 15. 3 13. 1 Females Males 11. 2 13. 2 19. 7 16. 3 Females Males 52. 8 47. 4 38. 3 37. 1 6. 0 9. 4 11. 8 19. 9 Stage distribution (%) Localized Metastatic Median survival all patients (monts) Relative survival all pts. (per cent, 5 -year) The Cancer Registry of Norway 2016 1527 1678

Number of general thoracic operations reported 1800 1633 1568 1600 1513 1448 1400 1328 1325 2009 2010 1561 1478 1463 2014 2015 1530 1200 1000 800 600 400 200 0 2011 2012 2013 2016 Norwegian Association for Cardiothoracic Surgery 2017 2018

Number of operations per hospital per year 450 400 350 342 300 2014 262 2015 240 250 2016 2017 200 2018 164 150 100 81 78 61 50 * 0 0 Rikshosp Ullevål AHUS Tr. Heim Haukeland Norwegian Association for Cardiothoracic Surgery Tromsø Stavanger Bodø Kalnes *No operations reported for 2018

Accesses used 900 800 764 700 649 600 2014 2015 500 2016 2017 400 2018 300 200 100 44 22 1 Norwegian Association for Cardiothoracic Surgery t bo Ro s to no er St in st M ed ia m co p os sc op co ra Th o ie ie s ie om ot ac or Th s 0

Underlying diagnoses 900 803 800 700 600 500 2014 2015 400 2016 300 2017 2018 200 127 123 100 119 106 53 60 53 48 17 13 3 Norwegian Association for Cardiothoracic Surgery r he Ot S TO ry ju In es rm fo De ee (d n In fe c tio ng lu t. In iti p) e se di tu gn ni Be ta ce r Un as or m m in tu as ta et M g/ tin ea Sw or se s g in sh flu ot m eu Pn M al . T ho um ra x or 0

Organ operated upon 1200 1093 1000 800 2014 600 2015 2016 2017 400 2018 179 200 83 59 54 52 4 3 Th. Norwegian Association for Cardiothoracic Surgery he a ac Tr ap pe rtu r us m tis e rv Th y su e ra eu Pl l al tw es Ch Ne M ed ia Lu n g st in um 0

Selected operations performed 140 117 120 100 83 80 2014 66 2015 60 53 2016 50 2017 40 40 2018 21 20 3 2 ta y co s m Norwegian Association for Cardiothoracic Surgery Re s. 1. to ec ym Th Op r. tu m or De ou co ts rti id e ca lu tio ng n l Co rr. Th. w m ct o Sy m pa te ct re eu pl g/ in bb Ru al y y om y m ct o lle Bu Di ag . / Bi op sy 0

Number of operations for lung metastases performed annually 200 187 184 180 166 168 156 160 167 154 146 140 139 115 120 100 80 60 40 2009 2010 2011 2012 2013 2014 2015 2016 Norwegian Association for Cardiothoracic Surgery 2017 2018

Operations for lung cancer 800 750 692 700 604 600 590 * 703 626 601 599 2013 2014 521 490 500 400 300 200 100 0 2009 2010 2011 2012 Norwegian Association for Cardiothoracic Surgery 2015 2016 2017 2018 * The Cancer Registry has registerted 729 operations in 2018

Number of operations for lung cancer per hospital per year 180 161 160 154 144 136 140 2014 120 2015 2016 100 2017 2018 80 71 60 44 40 40 18 20 * Norwegian Association for Cardiothoracic Surgery Bo ge r an St av Tr o m sø d Ha uk el an m ei US AH l vå le Ul Tr H Ri ks h os p 0 dø 0 * The Cancer Registry has registererd 19 operations

Prosedures performed in operations for lung cancer 700 585 600 500 2014 2015 400 2016 2017 300 2018 200 100 53 48 49 10 7 Norwegian Association for Cardiothoracic Surgery op ch on Br Su blo ba la rr om ct be Lo st y es y y be Bi -lo on m Pn eu ct m ec to io at pl or ex ly On om y n 0

The number (bars) and percentage (line) of lobectomies for lung cancer completed by VATS 350 50 326 327 44 300 271 45 40 250 35 30 200 185 Number VATS operations 25 Percentage. VATS operations 151 150 20 101 15 100 49 50 9 10 50 5 18 0 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Norwegian Association for Cardiothoracic Surgery

From the Cancer Registry of Norway, 2018 Figure 3. 16 The percentage of resections for lung cancer performed by thoracoscopy (VATS)

The percentage of patiens beeing females in surgery for lung cancer 450 60 400 53 50 300 40 Males 250 Number operations 30 Percentage females Females 200 % females 150 20 10 50 0 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Norwegian Association for Cardiothoracic Surgery

Age – quartiles for those operated for lung cancer Data extracted from 6102 operations 75 74 73 73 71 70 69 69 67 Males 75 % Females 75 % Males 50 (median) Age - years 65 64 63 63 Females 50 (median) Males 25 % Females 25 % 61 59 57 55 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Norwegian Association for Cardiothoracic Surgery

The number (bars) and percentage (line) of patients operated for lung cancer being 80 years or older 45 6 5, 6 40 5 35 Number operations 30 4 25 Percentage Number of operation 3 Percentage 20 15 2 10 1 5 0 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 Norwegian Association for Cardiothoracic Surgery 2018

Figure 3. 26 Survival – up to 12 months for patients diagnosed with lung cancer 2016 – 2018. The Cancer Registry of Norway Stages I, III and IV. http: //www. kreftregisteret. no/ Norwegian Association for Cardiothoracic Surgery

From The Cancer Registry of Norway, 2018 Figure 1. 1 The indicators for quality for the treatment and the reporting to The Cancer Registry.

From The Cancer Registry of Norway, 2018 Figure 5. 4 The proportion of the operations that are reported to The Registry, and the median time (in days) from surgery to reporting.

From The Cancer Registry of Norway, 2018 Figure 3. 14 The “flow” for patients operated for lung cancer in 2018. From left: the 1 -year relative survival for all patients with lung cancer in the respective hospital areas, the proportion operated, the flow from local hospitals to hospitals performing the surgery, the 30 days mortality and 1 -year relative survival for those operated.

From The Cancer Registry of Norway, 2018 Figure 3. 14 The proportion of the patients operated within the first two weeks after decision.

28 Per cent of those diagnosed that have been operated for lung cancer Data from The Cancer Registry of Norway 26 24 23, 0 22 20 Per cent 18 16 16, 2 14 12 10 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

From The Cancer Registry of Norway, 2018* Figure 3. 12 The proportion of the patients given curative treatmet – surgery, stereotactic radiation or fractionated radiotherapy. *Wide bars 2018, tiny bars 2017.

From The Cancer Registry of Norway, 2018 Figure 3. 17. 30 days mortality after surgery for lung cancer

From The Cancer Registry of Norway, 2018 Figure 3. 18. 90 days mortality after surgery for lung cancer

The outcome for patients with metatases is still poor, however, for a subgroup there has been an increased survival Figure 3. 24 Survival for 25, 50 and 75 percentile of patients with metastatic lung cancer The Cancer Registry of Norway

Papers presenting lung cancer in Norway Norwegian Association for Cardiothoracic Surgery

THANK YOU