title: Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer.
abstract: OBJECTIVE
  Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP).
  
  
  METHODS
  We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends.
  
  
  RESULTS
  Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% (P < .0001) and 22% to 34% (P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size (P = .61), or cell type (P = .81).
  
  
  CONCLUSIONS
  The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection.
authors: Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY.
authors: Raja
authors: R
authors: Flores
authors: Department of Surgery, Christiana Care, Helen F. Graham Cancer Center, Newark, Del.
authors: Thomas
authors: T
authors: Bauer
authors: Department of Surgery, Swedish Medical Center, Seattle, Wash.
authors: Ralph
authors: R
authors: Aye
authors: Department of Surgery, South Nassau Communities Hospital, Long Island, NY.
authors: Shahriyour
authors: S
authors: Andaz
authors: Department of Surgery, Upstate Medical Center, Syracuse, NY.
authors: Leslie
authors: L
authors: Kohman
authors: Department of Surgery, Mills-Peninsula Health Services, San Mateo, Calif.
authors: Barry
authors: B
authors: Sheppard
authors: Department of Surgery, Wellstar Health System, Marietta, Ga.
authors: William
authors: W
authors: Mayfield
authors: Department of Surgery, Jackson Memorial Hospital, University of Miami, Miami, Fla.
authors: Richard
authors: R
authors: Thurer
authors: Department of Surgery, Georgia Institute for Lung Cancer Research, Atlanta, Ga.
authors: Michael
authors: M
authors: Smith
authors: Department of Surgery, The Valley Hospital Cancer Center, Paramus, NJ.
authors: Robert
authors: R
authors: Korst
authors: Department of Surgery, John Muir Cancer Institute, Concord, Calif.
authors: Michaela
authors: M
authors: Straznicka
authors: Department of Surgery, City of Hope National Medical Center, Duarte, Calif.
authors: Fred
authors: F
authors: Grannis
authors: Department of Surgery, New York University Medical Center, New York, NY.
authors: Harvey
authors: H
authors: Pass
authors: Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY.
authors: Cliff
authors: C
authors: Connery
authors: Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY.
authors: Rowena
authors: R
authors: Yip
authors: Department of Medicine, Weill Cornell Medical College, New York, NY.
authors: James P
authors: JP
authors: Smith
authors: Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY.
authors: David
authors: D
authors: Yankelevitz
authors: Department of Surgery and Radiology, Icahn School of Medicine at Mout Sinai, New York, NY. Electronic address: claudia.henschke@mountsinai.org.
authors: Claudia
authors: C
authors: Henschke
authors: Department of Cardiovascular Surgery, Weill Cornell Medical College, New York, NY.
authors: Nasser
authors: N
authors: Altorki
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States; D019564:Unnecessary Procedures