Ten Unfamiliar Thoughts On AZD4547

Preoperative PET scanning was performed in 102 of the 130 patients (78.5%), compared with none of the patients in the 1993 survey. Fewer patients out of the 2003 study cohort diagnosed with NSCLC had their lung cancer resected than in 1993 (130/655 cf. 161/635, P?=?0.02; 95% CI: 17�C23% cf. 22�C29%). A higher proportion was explored without resection (��futile thoracotomy��) in 2003 (15/145 cf. 7/168, P?=?0.03; 95% CI: 6�C16% cf. 2�C8%). The 30-day mortality was no different between the two surveys. Age-adjusted 5-year survival was no different between 1993 and 2003. Data on resection margin status were not available from the 1993 survey. A comparison, however, was possible with the prospective Australian Thoracic Surgery Database administered from Austin Cisplatin supplier Hospital, Heidelberg, Victoria, which yielded 54 incomplete margins from 1452 lung cancer resections (Simon Knight, pers. comm., 2011), undertaken exclusively by Victorian specialist thoracic surgeons. This local benchmark rate of 3.7% (95% CI: 2.9�C4.8%) was substantially less than the 20.8% in the survey cohort (P?selleck products be safe according to the Victorian Audit of Surgical Mortality.[5] The results of lung cancer resection surgery in this survey concur with these findings, with a low mortality by population-based standards.[6-8] Despite half of the patients being older than 70 years, the 30-day mortality was only 1.5% (95% CI: 0.4�C5.4%), substantially lower than the other similar published series from Western Australia[4] and well within the range quoted in clinical guidelines.[9, 10] On initial impression, a lower surgical intervention rate in 2003 could be seen as an advance, given that the age-adjusted survival of the entire cohort was not significantly lower than in 1993. However, it may represent lost opportunities to cure in 2003 and/or that incomplete resection rates were just as poor in 1993. Given the advances in perioperative care and the addition of PET scanning to further rule out futile thoracotomies, it could be expected that crude survival rates and intervention rates remain the same despite the ageing population, and perhaps even improve. Unfortunately, INPP5D the results show that even with the lower intervention rate, the ratio of futile thoracotomies for ��inoperable�� tumors was more common in 2003. Therefore, better selection cannot be claimed. The possibilities therefore include increasing nihilism toward surgery for lung cancer, fewer resectable cases by chance, or surgeons operating only on patients with the lowest mortality risk, denying the more borderline cases a chance for cure. Variation in lung cancer patient volume between surgeons in Victoria may contribute to differences in patient selection and familiarity with oncologic principles.