Comparison of treatment outcomes in propensity score matched primary lung cancer patients offered anatomical lung resection or oncological treatment following a thoracic high risk multidisciplinary team meeting.

Background: High-risk multidisciplinary team (HRMDT) meetings are increasingly implemented for management of high-risk non-small cell lung cancer (NSCLC) patients. However, the safety of surgery is often still questioned, resulting in treatment being diverted towards a "safer" non-surgical oncological treatment option. This study investigates the post-treatment outcomes, including survival, between propensity matched high-risk patients who, after discussion at the HRMDT, receive either surgery or oncological treatment. Methods: A retrospective analysis of pre-and post-operative variables between high-risk patients referred to the HRMDT, held fortnightly, from 2019-2023 was conducted. Referral criteria to HRMDT are: poor lung function tests, ≤2 important co-morbidities, performance status (PS) ≤2, age ≥85 years, body mass index ≥40 or ≤16 kg/m Results: Overall, 168 patients were analyzed [mean age 72.3±2.2 years, 73 (43.4%) males]. After matching, 63 patients were included in each group. Longer length of stay (LOS; median 5 Conclusions: Overall survival and disease-free survival were longer in high-risk patients treated with surgery. Similar findings were found per NSCLC stage but LOS was longer while complications and unplanned admissions to critical care were more frequent. Surgery should not be precluded from the treatment of high-risk NSCLC patients, discussed at a HRMDT.