Korea sees surge in lung cancer surgeries among elderly, women: 14-year data

The landscape of lung cancer surgery in Korea is undergoing significant changes. Over the past 14 years, there has been a notable increase in the number of elderly and female patients.

Professor Park Seong-yong of the Department of Thoracic and Cardiovascular Surgery and Professor Kang Dan-bi of the Clinical Epidemiology Research Center at Samsung Medical Center, Dr. Cho Su-jin of the Health Insurance Review and Assessment Service, and Professor Hahm Myung-il of the Department of Health Administration and Management at Soon Chun Hyang University announced on Friday that they had published the results of their analysis of national health insurance claims data and robotic surgery procedures for lung cancer surgeries from 2010 to 2023 in the Journal of Korean Cancer Research Association, the official journal of the Korean Cancer Association.

According to the study, the number of lung cancer surgeries increased more than threefold, from 4,557 in 2010 to 14,184 in 2023. The incidence rate of lung cancer per 100,000 people also rose from 42.8 to 61.6.

The research team noted that while the age-standardized incidence rate showed no significant difference from the past, the increase in patients was attributed to the growing size of the elderly population.

According to National Cancer Registry, thyroid, breast, colorectal, stomach, and lung cancers are the most common cancers among people aged 35 to 64. However, among those aged 65 and older, lung cancer is the most common, followed by colorectal, stomach, prostate, and liver cancers.

The research team also noted that the increase in female patients is worth paying attention to. The proportion of female patients increased from 32.0 percent in 2010 to 44.7 percent in 2023.

Most female lung cancer patients are non-smokers, so it is estimated that various factors, such as secondhand smoke, cooking, and air pollution have combined to play a role rather than direct exposure to smoking.

“The increase in female patients is attributed to the widespread adoption of low-dose CT scans for screening and the creation of conditions conducive to the disease due to increased average life expectancy,” the research team said. “As the patient population changes, it is also time to consider adjustments in treatment approaches.”

There has also been an increase in cases where high-risk patients who would have hesitated to undergo surgery in the past are now crossing the threshold of the operating room. The proportion of patients aged 70 to 79, who begin to experience increased surgical risks due to age, rose from 26.3 percent to 32.3 percent during the period. The proportion of patients aged 80 and older also increased from 2.0 percent to 6.2 percent.

Additionally, the proportion of patients with a Charlson Comorbidity Index (CCI) of 7 or higher, indicating a high surgical risk due to severe comorbidities, rose sharply from 9.0 percent to 17.4 percent.

The research team attributed this increase to improvements in early diagnosis and surgical techniques. As recently as 2010, the rate of video-assisted thoracoscopic surgery was only 52.9 percent, but by 2023, 94.8 percent of patients underwent this procedure. Thoracoscopic surgery is known to be less burdensome for patients compared to open thoracotomy.

Robotic surgery accounts for only 3.17 percent of all surgeries, but in 2023, the number of robotic surgeries exceeded 450 for the first time, surpassing the number of open surgeries (291).

Lung-sparing wedge resection increased from 8.2 percent to 18.5 percent, and segmental resection rose from 4.2 percent to 9.6 percent. This means that patients with high surgical risks, such as the elderly and those with comorbidities, now have safer options for surgery.

Lung cancer surgery outcomes have also improved. The length of hospital stay for lung cancer surgery patients was reduced by nearly half, from 13 days in 2010 to seven days in 2023, and the 30-day mortality rate also decreased significantly, from 2.45 percent to 0.76 percent.

“This study is the first in Korea to analyze 14 years of nationwide lung cancer surgery big data and comprehensively present changes in the number of surgeries, patient characteristics, surgical methods, and treatment outcomes,” Professor Kang said.

Professor Park said, “Although an environment has been established where elderly, female, and patients with comorbidities can safely undergo surgery, disparities in medical access and outcomes still exist, so evidence-based policy establishment and improvements in surgical quality are necessary.”