Original articles: General thoracic
Who should follow up lung cancer patients after operation?

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Abstract

Background. It is unclear whether follow-up by a thoracic surgeon after lung cancer resection alters survival.

Methods. The charts of 245 early stage (≤ IIB) non–small cell lung cancer patients, diagnosed between 1988 and 1995, were reviewed. Follow-up data were complete to January 1, 1997, in 96.3% (236 of 245) of cases.

Results. Ninety of the 111 recurrences were detected before discharge from the thoracic clinic. Despite clinic follow-up, 66.7% (60 of 90) were identified by the family physician, and only 28.9% (26 of 90) by the surgeon. The remaining 4.4% (4 of 90) were detected by other physicians. Ninety-six percent (25 of 26) surgeon-detected recurrences had suspicious clinical or chest radiographic findings, compared with 92% for family physician–detected recurrences (55 of 60; not significant). The cost per recurrence detected by surgeons was Can $4,367. A 75% cost savings could ensure if patients were followed up by their family physician. There was no 5-year survival benefit for patients whose recurrence was detected by the surgeon.

Conclusions. Long-term follow-up after limited-stage non–small cell lung cancer resection could possibly be performed by a family physician alone without compromising overall survival, and with significant cost savings.

Section snippets

Patients and methods

The Kingston General Hospital database was searched to identify patients treated surgically for a pulmonary neoplasm between January 1, 1988, and December 31, 1995. The following exclusion criteria were applied: (1) malignancy other than NSCLC stage IA to IIB, (2) history of previous pulmonary malignancy, (3) synchronous lung cancer primaries, (4) inability to withstand pulmonary resection, (5) use of adjuvant therapy (eg, radiation, chemotherapy), and (6) death within 30 days of operation.

The

Results

The study group included 245 surgically treated stage IA to IIB NSCLC patients. A total of 344 patients were scheduled for surgical treatment of an NSCLC between 1988 and 1995. Patients with stage III to IV NSCLC tumors were excluded. Of the remaining 268 patients, 8 died within 30 days of operation (3.2%), 6 could not tolerate pulmonary resection at the time of thoracotomy, 5 received adjuvant radiation therapy, 3 had a positive history of pulmonary neoplasm, and 1 patient had synchronous

Comment

Arguments in favor of routine surveillance of postoperative lung cancer patients include the potential for early detection of a recurrence or a new primary aerodigestive tract tumor 6, 7. Identification and treatment of potential complications of the operation, along with maintenance of a good surgeon–patient relationship, are also part of the rationale for routine follow-up [4]. Such practice is ingrained in surgery residency training, and its justification is probably based more on surgical

Acknowledgements

Supported by E.J.P. Charrette Memorial Research Fund, Queen’s University, Canada.

References (9)

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