The Changing Landscape of Lung Cancer Resection Outcomes Over the Past two Decades.

Introduction: Recent advances in cancer management may have transformed the overall prognosis of patients undergoing lung cancer resection. This study aimed to assess the changes in the long-term survival of patients undergoing surgery for lung cancer over the last 2 decades and to identify the risk factors modulating the postoperative prognosis.

Methods: This single-center retrospective study included nonsmall cell lung cancer patients who underwent lung resection between 2008 and 2020. Exclusion criteria included prior lung cancer or resection, diagnosis of lung metastases, small cell lung cancers, carcinoid tumors, or benign tumors. Multivariate models analyzed determinants of short- and long-term outcomes over time.

Results: Among 2898 lung resections performed, 768 deaths (26.5%) occurred, including 25 (0.9%) in the 30-day postoperative period. Postoperative complications were observed in 1063 cases (36.7%), with 535 (18.5%) being respiratory-related. No significant improvement was observed in 30-day postoperative complications or deaths over time. Conversely, the adjusted hazard ratio (HR) for mortality was 0.72 (95% CI, 0.57-0.92) and 0.59 (95% CI, 0.45-0.78) for the in 2012-2015 and 2016-2020 periods compared to 2008-2011. In multivariate analyses, increasing age, current smoking at the time of surgery, pneumonectomy, advanced cancer stage and lower socioeconomic status were associated with worse outcomes.

Conclusions: Over the past 2 decades, long-term survival after lung cancer resection has significantly improved, despite stable rates of early postoperative complications. Efforts to develop curative treatments for advanced stages remain crucial while public health initiatives must address socioeconomic disparities to further improve lung cancer outcomes.