Report from the European Society of Thoracic Surgeons Database 2017: patterns of care and perioperative outcomes of surgery for malignant lung neoplasm.

OBJECTIVES: The European Society of Thoracic Surgeons (ESTS) registry was created 10 years ago and represents an international database collecting thoracic surgery procedures from European contributors. The purpose of the present report was to offer an overview of baseline and surgical characteristics and outcomes of patients submitted to lung resections for malignant lung disease as derived from the ESTS registry.

METHODS: We retrieved data about all lung resections from 2007 to 2016 performed for primary and metastatic (secondary) lung cancer. We evaluated the baseline characteristics and the surgical management of this population. Within the subgroup of patients affected by primary lung cancer, we described the preoperative mediastinal staging management and the final pathological stage of disease. Finally, we analysed the morbidity and mortality rates for the cohort of patients submitted to anatomic lung resections for primary or secondary lung cancer. Outcomes were also evaluated in relation to several risk factors: type of resection, age, comorbidity, predicted postoperative forced expiratory volume in 1 s and surgical approach.

RESULTS: We selected 62 774 patients submitted to lung resections (male 66.5%, median age 64 years). For the entire population, median predicted postoperative forced expiratory volume in 1 s was 73.3% (interquartile range: 59, 87.6), 33.8% of patients had cardiac comorbidities and 17.3% had other comorbidities. Among the patients with primary lung cancer (51 931 patients), 50.8% had Stage I disease and 23.2% Stage II disease; preoperative invasive mediastinal staging was performed in 70.3% of patients with computed tomography scan nodal enlargement and positron emission tomography scan nodal uptake. After anatomical lung resection (51 756 patients), overall morbidity was 18.5% and mortality (30 days or in-hospital) was 2.6%. Extent of resection, age ≥75 years, presence of cardiac comorbidity, predicted postoperative forced expiratory volume in 1 s <70% and open approach instead of video-assisted thoracic surgery were associated with worse outcomes.

CONCLUSIONS: The results of the present report represent reliable European benchmarks for comparing the activities and outcomes of single institutions and surgeons at an international level.