Low Lung Cancer Resection Rates in a Tertiary Level Thoracic Center in Nepal - Where Lies Our Problem?

Background: Resection rates of lung cancer are low in general and especially in countries like Nepal. Advancedstage at presentation and poor general condition of the patient are the usual causes. Materials and
Methods: Inthis prospective observational study, one hundred cases of lung cancer who presented at the Thoracic Surgery Unitbetween October 2011 and October 2012 were included.
Results: Those aged in the 6th and 7th decades togetheraccounted for 72/100 patients. The male to female ratio was 2:1. There was a mean-29.2±14.2 pack yrs smokinghistory with only five non-smokers. Seventy-six patients presented with locally advanced disease while 21 hadmetastases. Only three had local disease. The average time between onset of symptoms to first contact with adoctor was 2.3±5.3 months (range: 0-35.6 months). Average time between first contact to referral was 50.4±65.7days (range-0-365). Only three patients were resected, one after neo-adjuvant chemotherapy. Advanced diseasewas the cause of unresectability in 95 cases. One of three patients with local disease had pulmonary functionsallowing the warranted resection. N2 disease with T1-3 on CT scan was found in 47. Three of these patientsunderwent mediastinoscopy and all confirmed uninvolved N2.
Conclusions: Lung resection rates in our centerremain low. Late presentation leading to advanced disease and poor pulmonary reserves preclude resection inmost cases. More liberal use of mediastinal staging and better assessment of pulmonary functions may allow usto improve resection rates.