Surgical resection update

In this update, data on surgical resections for lung cancer, focusing on types of cancer, stages, procedures performed, and diagnostic procedures, is presented. The images provide insights into the trends and patterns observed in lung cancer surgeries over recent years.

• Lung cancer
• Resections
• SWAG Lung CAG
• Data analysis
• Surgical procedures

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1. Surgical resection update Eveline Internullo SWAG Lung CAG - 21st May 2019

2. SWAG Lung CAG - 21st May 2019

3. SWAG Lung CAG - 21st May 2019

4. LCCOP 2018 (2016) SWAG Lung CAG - 21st May 2019

5. 27 units 125 thoracic surgeons Median: 203 Median per surgeon: 46 Data submitted for LCCOP 2019 (2017) 240 lung cancer resections SWAG Lung CAG - 21st May 2019

6. Types of lung cancer operated in 2016 (LCCOP 2018) 93% NSCLC 450 400 350 Increasing number of operations for carcinoid tumours: 87% in 2 years 300 250 200 150 100 50 0 2014 2015 2016 SWAG Lung CAG - 21st May 2019

7. Stages of lung cancer operated in 2016 (LCCOP 2018) 81% 12.9% SWAG Lung CAG - 21st May 2019

8. Types of procedure for lung cancer operated in 2016 (LCCOP 2018) 4% 77% 17% SWAG Lung CAG - 21st May 2019

9. Primary lung cancer resections by procedure performed 2015/6-2017/8 UHB 180 1 Pneumonectomy including sleeve pneumonectomy 160 140 2 Lobectomy, bilobectomy 120 100 3 Sleeve resection lobectomy 80 60 40 4 Segmentectomy 20 0 5 Wedge resection 15-16 16-17 17-18

10. Procedures for primary lung cancer: proportion by VATS 2015/6-2017/8 UHB 100 1 Pneumonectomy including sleeve pneumonectomy 90 80 70 2 Lobectomy, bilobectomy percentage VATS 60 50 3 Sleeve resection lobectomy 40 30 4 Segmentectomy 20 10 0 5 Wedge resection 15-16 16-17 17-18

11. Selected diagnostic procedures 2015/6-2017/8 UHB 120 5 Mediastinoscopy / mediastinotomy 100 80 3 Diagnostic pleural biopsy(+/- pleuredesis or other) 60 40 6 Wedge resection (biopsy e.g. interstitial disease or biopsy for multiple nodules) 20 0 15-16 16-17 17-18

12. Mortality for lung cancer operated in 2016 (LCCOP 2018) Survival England UHBristol 30 days 98.2% 98.1% 90 days 96.5% 97% 1 year 88.7% 88.3% SWAG Lung CAG - 21st May 2019

13. Mortality for lung cancer operated in 2016 SWAG Lung CAG - 21st May 2019

14. SWAG Lung CAG - 21st May 2019

15. SWAG Lung CAG - 21st May 2019

16. SWAG Lung CAG - 21st May 2019

17. SWAG Lung CAG - 21st May 2019

18. NLCA 2018 (2017) 16.6% (unadjusted) SWAG Lung CAG - 21st May 2019

19. NLCA 2018 (2017) adjusted* resection rates Surgery - unadjusted Surgery - adjusted Alliance 16.6% 16.1% Weston 18.1% 17.5% Yeovil 14.1% 13.7% UH Bristol 19.5% 15.9% Taunton 15.6% 16.4% Bath RUH 16.3% 17.8% Gloucester 14.2% 14.7% North Bristol 18.7% 16.7% *for age, sex, stage, PS and socio-economic status SWAG Lung CAG - 21st May 2019

20. SWAG Lung CAG - 21st May 2019

21. 73.5%

22. SWAG Lung CAG - 21st May 2019

23. NLCA 2018 (2017) adjusted* resection rates Surgery - unadjusted Surgery - adjusted NCLA 2017 NCLA 2018 NCLA 2017 NCLA 2018 Alliance 13.2% 16.6% 14.9% 16.1% Weston 15.2% 18.1% 16.8% 17.5% Yeovil 15.7% 14.1% 14.9% 13.7% UH Bristol 16% 19.5% 17% 15.9% Taunton 11.7% 15.6% 12% 16.4% Bath RUH 7.3% 16.3% 11.4% 17.8% Gloucester 16.6% 14.2% 14.6% 14.7% North Bristol 18.5% 18.7% 17.9% 16.7% *for age, sex, stage, PS and socio-economic status SWAG Lung CAG - 21st May 2019

24. What next? Surgeons attendance to MDTs Telly link Patients optimization for surgery - smoking cessation - COPD management - CPET - cardiology review - pulmonary rehabilitation - surgical second opinion CCRM PreVid Pathway optimization (NOLCP) - Minimize admin dead times (MDT to clinic appt) - Bundles - pooled lists - capacity (theatres, HDU) Fast Referral Forms OPA < 7 days One-stop clinic SWAG Lung CAG - 21st May 2019