Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Hospital lung surgery volume and patient outcomes in Victoria (#69)

Alesha Thai 1 , Ella Stuart 2 3 , Luc te Marvelde 2 3 , Simon Knight 4 , Roger Milne 2 , Kathryn Whitfield 3 , Paul Mitchell 1
  1. Department of Medical Oncology, ONJWC, Austin Health, Heidelberg, VIC, Australia
  2. Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Victoria, Australia
  3. Cancer Strategy and Development, Department of Health and Human Services, Victoria, Australia
  4. Department of Surgery, Austin Health, Heidelberg, Victoria, Australia


We evaluated the relationship between hospital non-small cell lung cancer (NSCLC) surgery volume and patient outcomes in Victoria.


Victorians with a primary diagnosis of NSCLC between 2008 and 2014 were identified in the Victorian Cancer Registry (n=15,827), 3,177 (21%) of whom had surgery. Primary outcome was death within 90 days of surgery and secondary outcomes were overall survival, use of postoperative ventilation, ≥24hours spent in ICU and length of stay >17days. Hospital volume quartiles were defined as Q1: 1-17, Q2: 18-30, Q3: 31-53 and Q4: 54+ surgeries per year.


56% (1,767/3,177) underwent lobectomy, 39% (1,241/3,177) sub-lobar resection and 5% (169/3,177) pneumonectomy. There was a weak linear relationship between lower hospital volume and greater 90-day mortality in patients undergoing sub-lobar resections, but not lobectomy, after adjustment (p-trend 0.1). The relationship was statistically significant when metastatic disease was removed as a covariate from the model, suggesting patient selection played a significant role (p-trend 0.03). Hospitals in the lower quartiles resected more patients with metastatic disease (Q1. 12% vs. Q4. 6% p-trend <0.001). Patients operated in lower volume centres had more admissions in ICU ≥24hours (Q1. 12% vs. Q4. 48%, p-trend <0.001). Median overall survival was 5.7 years, 4.8 years and 5.8 years for lobectomy, sub-lobar resection and pneumonectomy, respectively. Survival was higher compared to NSW and overseas data despite similar resection rates.


Case selection appears to play a significant role in poorer outcomes after sub-lobar surgical resection in lower volume centres. There are a greater proportion of patients with metastatic disease undergoing surgery in lower volume centres thus affecting patient outcomes.