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David Waller he's a well-known European drastic surgeon at glenfield hospital unless I want to describe to the effects we found of investing in thoracic surgery on lung cancer resection rates the background is that in the UK lung cancer has been under treated the sin that disease one of the benefits of this one of the aspects of this presentation has shown the benefit of the National lung cancer audit which is a way of recording all the data pertaining to lung cancer patients within our state healthcare system and our presentation is based on the analysis of its results within our national healthcare system I'm focusing now on England there are 33 cancer networks comprising 174 hospital trusts eighteen percent of these trusts have thoracic surgical centers but in fifty-eight percent of these trusts there are less than two pure thoracic surgeons in 2008 which is the last analyzed lung cancer ordered over 15,000 two confirmed cases of lung cancer were in the United Kingdom and fourteen percent underwent resection data from the Center for Workforce intelligence current data in England shows this distribution less than half in UK and the title of this presentation is that increased investment in Jurassic surgical expertise increased the UK lung cancer reset a pathway because of our state health care system virtually all cases of lung cancer are referred in from primary care to a specialist lung cancer service they are initially screened by a chess position and then discussed at a multidisciplinary team which will include a chess position an oncologist and hopefully in most cases a surgeon but this is the first point where the surgeon is involved in the lung cancer pathway and unfortunately it is the case in the United Kingdom that not all cases of lung cancer are discussed in the presence of a surgeon at the MDT the decision is made by the MDT then to refer the case on to the surgeon and as I'll show you in the United Kingdom if you have lung cancer you may or may not see a surgeon who has a specialist in trevors evidence that in comparison to other western and developed countries our treatment rates and survival for lung cancer for way below the accepted standards this has been focused on by the British media and hopefully some changes have been made as a result within our country of around 60 million people there is a wide variation in the access to lung cancer surgery as you can see from this mouth there are areas of the country which have a six-fold greater resection rate just to put that into perspective if you are an elderly patient with lung cancer in Cornwall you are six times less likely to get lung cancer surgery than if you live in Leicester and clearly this is of major concern both to the patients but also to the politicians as you can see here this again as it attracted the attention of the British media in the past this graph shows the resection rate adjusted for various confounding factors such as sex and age this is a real difference the backgrounds this is the standard UK lung cancer after the analysis of the 2008 data there were appointments in five of those 31 units of new specialist thoracic surgeons when we reanalyzed the changes in reception rates surprise surprise the increase in resection rate was greatest in those units who had employed new specialist thoracic surgeons what did this what does this analysis mean if we look at the implications for the lung cancer surgery workforce and we take the network that had the best resection rate in that data they had three pure thoracic surgeons who saw 450 new cases of lung cancer per year in their md teas and each surgeon attended on average 1.5 m dt is a week so if we use that as the gold standard and we plied that across at england for fifteen thousand seven hundred cases we would need 107 thoracic surgeons and if we looked at the MDT attendance that we kept the same number of em DTS we would need 113 surgeons now looking back to that workforce data if we assume that 63 of those mixed practice surgeons devoted half of their time to lung cancer surgery which we not sure that's true we have a current total of eighty nine whole whole time equivalents so you can see we are understaffed in terms of specialist thoracic surgical expertise so the bottom line if we want to maximize lung cancer resection rates England needs to recruit 25 to 30 new pure thoracic surgeons and there are several ways we could do that the surgeons operating our lung cancer are pure thoracic surgeons there are 63 surgeons whose practice combines both cardiac surgery and lung surgery and there are 114 surgeons whose surgery comprises entirely heart surgery our analysis in this presentation related the data from the National lung cancer ordered to manpower data obtained from that last source and these are the main findings lung cancer resection rates are higher in centers who treat more cases lung cancer resection rates are higher in patients who are first seen in one of the specialist centres the base centers where there is thoracic surgery rather than in the referring centres importantly lung cancer resection rates are higher in centers where there are two or more specialist thoracic surgeons as opposed to cardiothoracic surgeons and reflecting the lung cancer pathway lung cancer resection rates are higher significantly higher when surgeons attend preoperative M DTS and we found that we could increase the number of surgeons in training who currently train in both cardiac and thoracic and increase the number who were specially trained in thoracic surgery and particular lung cancer surgery perhaps we could persuade the surgeons who currently have a mixed practice to decide if they want to specialize in either cardiac or thoracic surgery failing that if our authorities don't realize the importance and don't train that don't change the training structure or our hospitals don't realize the importance of our surgeon specializing we could import new thoracic surgeons from within the EU but that of course would not be particularly acceptable to many of the population or medical specialities we hear a lot about the developments in new drugs and technology well put it to you that these have borderline effects on the overall survivorship in lung cancer there is unpublished data as yet to be released that shows that increasing the resection rate has a major impact on the population survival from lung cancer and there is data to suggest that if everyone all the center's move to the higher resection rate they could increase survival in lung cancer england by twelve percent which could approximate to over five thousand extra survivors from lung cancer over a three year period so surgery is still important brightly important in the treatment of lung cancer and the message is specialist lung cancer surgery is even more important thank you thank you dr. wall I think the message was very clear and the future for drastic surgery seems bright in UK any questions or comments yeah Stephen pin doctors net UK and the recommend recommendations that you've outlined very laudable but given the financial constraints facing the National Health Service in the UK are they feasible write for me capstone project for high school online The Debbie Friedman School of Sacred Music.