Operability of lung cancer at the Department of Pulmonology, 2nd Faculty of Medicine, Charles University and Motol University Hospital in Prague in 2024 and its development in the Czech Republic in the last 45 years.

Abstract

In 2024, the multidisciplinary team of the Department of Pulmonology, 2nd Faculty of Medicine, Charles University and Motol University Hospital discussed 454 cases of patients with lung cancer; There were 70 (16%) operated on that year. Patients with adenocarcinoma (52%) in TNM stages I to IIIB prevailed among the operated patients. We administered immunochemotherapy as neoadjuvant treatment to 18 of the operated patients, and 61% of them experienced complete pathological regression. Lobectomies (86%) were significantly more prevalent among surgical procedures, only once the procedure ended with exploratory thoracotomy. We have achieved a 55% agreement between cTNM and pTNM. No one died within 30 days after the operation. We compared the current results of lung cancer surgery with similar groups of patients from outpatient and clinical departments from the last 45 years. During this time, the number of indications for resection treatment did not increase. The proportion of morphological types of lung carcinoma has changed (increase in adenocarcinomas), procedures performed in patients (lobectomies clearly predominate today) and the number of patients operated on in stages IIIA and IIIB has increased slightly. The agreement between the clinically evaluated extent of the tumor and its actual size determined by the pathologist remains at a very good level, as in the past, and is comparable to the results of the most advanced centers in the world. The number of indications for resection depends on the timeliness of diagnosis. At present, less than 20% of patients with lung cancer are diagnosed in TNM stages I and II. We see a possible improvement in the increase in the number of participants in lung cancer screening using low-dose CT, which is well organized and available to all interested parties from 2022. The results of this screening known so far confirm a 57% representation of stages I and II of TNM in patients detected in this way.