Population-Based Patterns of Surgical Care for Stage IIIA XXXX in the Netherlands between 2010 and 2013.

@entity1 @entity1358 @entity1149 @entity5
INTRODUCTION: Current guidelines include both induction therapy plus an operation and chemoradiotherapy (CRT) as options for clinical stage IIIA (cIIIA) @entity1149 ( @entity1149 ) after multidisciplinary evaluation. We explored the use of operations for cIIIA @entity1149 in the Netherlands. METHODS: Data about the primary treatment of @entity1 with cIIIA @entity1149 (according to the seventh edition of the @entity5 , Node, and Metastasis Classification of @entity5 ) between 2010 and 2013 were extracted from the Netherlands Cancer Registry. Mortality information was obtained from the automated civil registry. RESULTS: A total of 4816 @entity1 with cIIIA @entity1149 (stage cN2, 3240 [67%]; stage T4, 1252 [26%]) were identified. CRT was used in 45% of @entity1 and an operation was a component of treatment in 15%, with 28% of the latter having induction therapy. The 4-year survival rate was highest with induction therapy plus an operation (51%), followed by an operation plus adjuvant therapy (39%) and CRT (27%). @entity1 receiving induction therapy plus an operation were younger than those receiving CRT (median age 60 versus 66 years). The 30- and 90-day postoperative mortality rates after induction therapy plus lobectomy were 0.6% and 3.7% compared with 4.2% and 12.5% after induction therapy plus bilobectomy or pneumonectomy. Factors associated with poorer survival after induction therapy plus an operation were age older than 69 years, histological findings of @entity1358 , and bilobectomy or pneumonectomy. Pathological stage IIIA @entity1149 was present in only 51% of @entity1 with cIIIA @entity1149 who underwent an operation with or without adjuvant therapy, and the disease was of a lower stage in most of the remaining @entity1 . CONCLUSIONS: In the Netherlands between 2010 and 2013, 15% of @entity1 with cIIIA @entity1149 received an operation, with the minority of these @entity1 receiving induction therapy. In those receiving induction therapy, 90-day mortality after bilobectomy or pneumonectomy was more than three times higher than that for lobectomy. The discrepancy between clinical and pathological stage in @entity1 receiving an upfront operation merits further investigation.
