Recent guidelines for the treatment of lung cancer include comprehensive lists of recommendations for pre-operative risk evaluation, staging, and surgery. Our aim was to evaluate whether the implementation of these in a population-based real-world setting would improve outcomes.

All patients diagnosed with primary lung cancer in Central Finland and Ostrobothnia between January 1, 2006, and December 31, 2017, were identified from registry data (N = 2116), including patients who underwent surgical resection (n = 303). Data were divided into two periods, old and modern, according to which international guidelines were followed.

Between surgical patients of the old and modern periods, significant changes occurred in the rate of pre-operative stair climbing tests (3.7 % vs. 68.6 %, p < 0.001), the use of positron emission computed tomography (18.7 % vs. 75.7 %, p < 0.001), and invasive staging (3.7 % vs. 26.0 %, p < 0.001). In surgery, the rate of VATS (2.2 % vs. 81.1 %, p < 0.001), segmentectomy (1.5 % vs. 27.2 %, p < 0.001), and extended resections (5.2 % vs. 13.6 %, p = 0.015) increased. However, between these periods, the rate of pneumonectomy decreased from 7.5 % to 1.2 % (p = 0.005) and bilobectomy from 9.0%-1.8% (p = 0.004). The overall resection rate increased from 10.5%-19.7 %, mainly due to a higher number of high-risk patients (12.7 % vs. 34.3 %, p < 0.001). Patients faced fewer major complications (21.6 % vs. 8.9 %, p = 0.002) and had shorter hospital stays (9 days, IQR 7-11 vs. 5 days, IQR 3-7; p < 0.001). In the modern period, patients underwent adjuvant therapy less often than in the old period (35.1 % vs. 22.5 %, p = 0.015). Recurrence-free 5-year survival rate improved, however, from 64.0%-76.8% (p < 0.001).

The introduction of guideline-based modern patient evaluation and treatment was associated with improved short- and long-term outcomes of lung cancer surgery.