Objective

The National Lung Cancer Audit publishes data annually including resection rates for NSCLC.These data are used to monitor performance of MDTs.The resection rate quoted most often is the biopsy confirmed NSCLC stage I-IV.This can unfairly discriminate against Units whose demographic of patients includes a higher proportion of more advanced disease.We hypothesised that biopsy confirmed stage I-II NSCLC resection rate would be a better measure of thoracic surgical performance.

Methods

We used data from the 2014 NLCA to calculate resection rates for each of the 28 Thoracic Surgery Units in England. cRR14 is the clinical NSCLC all stages, hRR14 is the histologically confirmed NSCLC all stages and hRR12 is the histologically confirmed stage I-II NSCLC resection rate. The Units were ranked and then divided in to quartiles to assess congruence between the resection rates.

Results

The highest resection rates were 26.3%, 30.1% and 63.9%, the lowest resection rates were 11.9%, 16.7% and 40.0% and the median resection rates were 16.1%, 22.0% and 54.7% for cRR14, hRR14 and hRR12 respectively. 87% of all NSCLC resections were performed for stages I-II. In Glasgow we had a hRR14 of 24.5% and hRR12 of 69.4% during the same period. 6 units moved ≥2 quartiles between hRR14 and hRR12 and for ten units there was no change. No unit moved ≥2 quartiles between cRR14 and hRR14.

Conclusion

These data show that ranking of Surgical Units has different results dependent on which resection rate is used. The majority of resections for NSCLC are for stage I-II. Using hRR14 can unfairly discriminate against Units whose demographic of patients includes a higher proportion of more advanced disease. We would recommend the use of hRR12 in preference to hRR14 to monitor and assess Thoracic Surgical performance.