Does the lung cancer screening (LCS) pathway independently improve surgical outcomes compared with the routine pathway: a matched-case analysis

BACKGROUND: Multiple randomised controlled trials demonstrate that screening is a game changer for lung cancer outcomes. As pilot Lung Cancer Screening schemes expand across the UK, we investigate whether referral through a screening pathway independently influences early postoperative outcomes following lung cancer resection, or whether observed benefits are due to differences in patient characteristics between screened and non-screened populations. METHODS: A retrospective cohort analysis was conducted on 370 patients who underwent curative lung cancer resection. Of these, 35 were from the Lung Cancer Screening pathway, while 335 were diagnosed from standard of care pathways. Propensity Score Analysis was then used to create a matched cohort of 34 patients per group to minimise confounding baseline factors such as clinical characteristics and patient demographics. Postoperative outcomes including complications, length of stay, and 30-day mortality were then compared using univariate logistic and linear regression models. Imputation was used for any missing data. RESULTS: Prior to matching, patients diagnosed via the Lung Cancer Screening pathway demonstrated more favourable baseline characteristics, subsequently requiring matching. Following matching, postoperative outcomes including length of stay (mean difference 1.81 days, p-value = 0.51), overall postoperative complication rate (OR -1.126, CI 0.701, 5.672, p-value = 0.195), complication severity objectively measured by Clavien-Dindo Classification (OR 2.039, CI 0.737, 5.638, p-value = 0.17), and Comprehensive Complication Index (OR 1.797, CI 0.644, 5.011, p-value = 0.263) were not statistically significantly different between the screened and non-screened populations. The 30-day mortality was 0% in the Lung Cancer Screening group, as opposed to 3.9% in the non-Lung Cancer Screening cohort (Absolute Risk Difference = 3.9%), however regression analysis could not be performed due to zero events in the screened group. CONCLUSIONS: The Lung Cancer Screening pathway appears to be indirectly associated with improved postoperative outcomes through patient selection rather than a direct, independent effect of the screening pathway. Larger studies are needed to validate these findings and elucidate how the downstream benefits of screening can be optimised across thoracic surgery pathways for lung cancer.