Current status of surgery for clinical stage IA lung cancer in Japan: analysis of the national clinical database

Abstract

Purpose As the number of cases of early lung cancer in Japan grows, an analysis of the present status of surgical treatments for clinical stage IA lung cancer using a nationwide database with web-based data entry is warranted. Methods The operative and perioperative data from 47,921 patients who underwent surgery for clinical stage IA lung cancer in 2014 and 2015 were obtained from the National Clinical Database (NCD) of Japan. Clinicopathological characteristics, surgical procedure, mortality, and morbidity were analyzed, and thoracotomy and video-assisted thoracic surgery (VATS) were compared. Results The patients comprised 27,208 men (56.8%) and 20,713 women (43.2%); mean age, 69.3 years. Lobectomy was performed in 64.8%, segmentectomy in 15.2%, and wedge resection in 19.8%. The surgical procedures were thoracotomy in 12,194 patients (25.4%) and a minimally invasive approach (MIA) in 35,727 patients (74.6%). MIA was divided into VATS + mini-thoracotomy (n = 13,422, 28.0%) and complete VATS (n = 22,305, 46.5%). The overall postoperative mortality rate was 0.4%, being significantly lower in the MIA group than in the thoracotomy group (0.3% vs 0.8%, P < 0.001). Conclusions Our analysis of data from the NCD indicates that MIA has become the new standard treatment for clinical stage IA lung cancer.

The impact of COVID-19 on surgical procedures in Japan: analysis of data from the National Clinical Database

“…The NCD is a nationwide web-based surgical patient registration system, which enables the collection of data on all surgical procedures performed in Japan, in addition to perioperative factors. More than 14,340,000 procedures, accounting for more than 90% of all surgeries performed in Japan during this period, have been registered by approximately 5,000 hospitals [ 6 , 7 ]. The NCD constructed software for an Internet-based data collection system and data managers in participating hospitals were responsible for forwarding their data to the NCD office [ 7 ].…”

Comparison of Postoperative Quality of Life and Pain with and without a Metal Rib Spreader in Patients Undergoing Lobectomy through Axillary Mini-Thoracotomy for Stage I Lung Cancer

“…Regarding the definition of surgical approaches, although each definition for VATS and mini-thoracotomy varied among reports, we basically adapted the definition of the national clinical database (NCD) registry in Japan. 21) According to this registry, all approaches with skin incision <8 cm regardless of the presence or absence of a rib spreader are registered as VATS. Moreover, the VATS cases in the NCD registry were divided into complete VATS (surgical manipulation under only monitor vision) and VATS+mini-thoracotomy (surgical manipulation under combined use of monitor and direct vision).…”

Virtual randomized study comparing lobectomy and particle beam therapy for clinical stage IA non-small cell lung cancer in operable patients

“…Based on this, PBT may be advantageous if operative mortality increases due to an underlying disease, even for young patients, whereas lobectomy may be advantageous for patients with underlying diseases, even for older patients. In addition, several studies have reported operative mortality can be reduced and that there is no difference in disease control rates when minimally invasive surgery like VATS and RATS are performed rather than an open thoracotomy [ 38 , 56 , 57 ]. When determining a treatment modality, it should be considered which surgical technique will be used.…”