Lung cancer without metastases--are all patients with resectable tumor operated?

Only 17% of patients with lung cancer are surgically resected, and the resection rate has not improved despite more attention about the disease. All patients with resectable disease should be offered operation and we wanted to investigate whether this is the case. We assessed patients that received the diagnosis localized lung cancer in the period 2003-2005 and were not resected according to the Cancer Registry of Norway (n = 322). After exclusion of 40 patients, 282 remained for evaluation. The Cancer Registry of Norway had received clinical reports for 253 patients. Lung physicians had filled in less than half of these, and TNM was registered appropriately in 37% of all reports. Despite that all patients had been categorized in the Registry as having localized lung cancer, 55 patients had advanced disease. Poor lung function, high age and serious comorbidity were contraindications towards surgery for patients with localized disease. Of 282 patients, 258 were inoperable while nine had undergone resection. The remaining 15 cases were thus classified as being operable or possibly operable. The proportion of patients who had not undergone resection and were assessed as operable has decreased. Legally required reporting to the Cancer Registry is still insufficient. Introduction of a specific report form for these patients may facilitate treatment evaluation and thereby treatment and ensure that the decision to not operate is well documented.