Perioperative Outcomes of Lung Cancer Surgery in Women: A Canadian Nationwide Retrospective Cohort Study

TL;DR

This study finds that women undergoing lung cancer surgery in Canada have lower mortality and fewer major complications compared to men, though they face higher rates of minor complications.

Contribution

The study provides new insights into sex-based differences in lung cancer surgery outcomes using a large Canadian national cohort.

Findings

Female patients had lower mortality and major complication rates but higher minor complication rates after lung cancer surgery.

Females were less likely to be smokers, have comorbidities, or develop squamous cell carcinoma compared to males.

Women with COPD or squamous cell carcinoma had higher odds of postoperative air leak complications.

Abstract

Sex differences in perioperative outcomes following lung cancer surgery remain understudied. This study evaluated these differences in a national cohort.

Data for patients who underwent lung cancer surgery between January 2017-December 2022 at 13 hospitals were extracted from the Canadian Association of Thoracic Surgeons National Database. Preoperative characteristics, surgery-related, tumour-related, and postoperative outcomes data were collected. Mixed-effects logistic regression models were used to determine perioperative variables associated with female sex.

A total of 9922 patients were included, and 55.4% were female. Female patients had higher rates of minor complications, lower rates of major complications, and lower mortality. Females were less likely to be active smokers (odds ratio [OR] = 0.66; 95% confidence interval [CI], 0.52, 0.83), have comorbidities, have squamous cell carcinoma (OR = 0.34; 95% CI, 0.26, 0.44), or an air leak complication postoperatively (OR = 0.66; 95% CI, 0.51, 0.86). However, females with chronic obstructive pulmonary disease (COPD) or squamous cell carcinoma had higher odds of experiencing an air leak complication postoperatively.

Females had fewer comorbidities, less advanced stage cancer, less pulmonary resection, and different tumour types, all leading to lower rates of major complications and mortality compared to males. Understanding preoperative factors that contribute to sex differences in adverse events can enhance the short- and long-term outcomes for patients with lung cancer.

Lung cancer is highly lethal and in Canada is responsible for 1 in 4 cancer-related deaths,1,2 contributing to more deaths than breast, colon, and prostate cancer combined.

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