Background: Surgical treatment for lung cancer has developed in recent
decades and has enabled surgical treatment of patients with increasingly
severe comorbidities. The aim of this study is to describe nationwide trends
in lung surgery: incidence of surgical treatment, operative mortality, changes
in surgical approaches, long term survival and predictors thereof in Finland
between 2004 and 2014.

Methods: Patients with any type of lung surgery and pre- or postoperative diagnosis of C34.* were identified from the national Care Register for Health Care which collects discharge data on all patients
discharged from inpatient care as well as outpatients treated in specialized
care. Patients were verified as lung cancer patients by linking data with
diagnoses from the Finnish Cancer Registry. Mortality data were linked from
Statistics Finland.

Results: During the study period 3912 patients underwent
lung surgery for cancer. Mean age was 66 years (SD 9.6), 62% were males. The
number of operations increased over the years (p=0.02). Extent of surgery was
pneumonectomy in 10%, lobectomy in 79.8% and sublobar resection in 10.2%.
Women underwent sublobar resection more often than men (8.2% vs 13.5%,
p<0.001). Overall 1 year survival was 85.5% and 5 -year survival was 51.4%.
Age, stage of cancer, Charlson comorbidity index (CCI) and the proportion of
lobectomy increased during the study period while survival remained stable.
Predictors of mortality on multivariable regression were age, male gender,
stage, CCI, pneumonectomy and adjuvant therapy.

Conclusion: Despite a growing number of patients with increasing comorbidities treated surgically
in a country with declining incidence of lung cancer and despite more
advanced disease postoperative mortality for surgically resected lung cancer
has remained stable. This suggests that modern surgical treatment could be
offered more confidently to more patients with heavier disease burden.