F-070LESS IS MORE: THE DECREASING RATE OF THORACOTOMY AND PNEUMONECTOMY IN LUNG CANCER SURGERY WITHIN CANADA

Objectives: Over the last decade, lung cancer surgery has seen significant changes in techniques and approaches with increasing evidence supporting video-assisted thoracic surgery (VATS) procedures and lung preservation. In our study, we sought to evaluate and quantify the types (pneumonectomy, lobectomy and sublobar resections) and approaches (VATS and Open) utilized for lung cancer resections in Canada over time. Methods: From 2004 to 2011, all patients in Canada (excluding Quebec) undergoing pulmonary resection for lung cancer were included. Data was obtained from the Canadian Institute for Health Information's Discharge Abstract Database. Patient factors, procedural case mix, and outcomes were evaluated. Descriptive statistics were performed to determine and evaluate the relative annual proportion of patients undergoing the differing types and approaches to lung cancer surgery as well as survival. Results: Of 25 555 cases analyzed, 48.4% were male, with an average age of 66.9 years. Over the study period, the proportion of patients undergoing pneumonectomy fell from 11.4% cases per year to 6.1%. The proportion of patients undergoing procedures with a VATS approach increased from 6.4% cases per year to 46.6%. Within groups, VATS sublobar resections increased from 12.8% of cases per year in 2004 to 58% in 2011, while VATS lobectomy increased from 3.87% to 43.9%. Overall unadjusted mortality rates shifted from 2.60% in 2004 to 1.14% in 2011. Conclusions: The last decade has seen considerable change in the surgical practice of thoracic surgeons in Canada. There has been a significant decrease in the number of thoracotomy and pneumonectomy procedures performed. Minimally invasive surgery has historically been adopted predominantly in simpler cases but has increasingly been utilized in lobectomy and other complex thoracic surgeries over time. Overall, the type and scope of practice facing the thoracic surgeon is dramatically different than it was a decade ago. Disclosure: No significant relationships.