Safety and Feasibility of Thoracoscopic Lung Resection for Non-Small-Cell Lung Cancer in Octogenarians

Abstract

Objective Octogenarians comprise an increasing proportion of patients presenting with non-small-cell lung cancer (NSCLC). This study examines postoperative morbidity and mortality, and long-term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC, compared with younger cohorts. Methods We conducted a retrospective review of our institutional Society of Thoracic Surgeons General Thoracic Surgery Database of all patients ≥60 years old undergoing elective lobectomy or segmentectomy for pathologic stage I, II, and IIIA NSCLC between 2009 and 2018. Results were compared between octogenarians ( n = 71) to 2 younger cohorts of 60- to 69-year-olds ( n = 359) and 70- to 79-year-olds ( n = 308). Long-term survival among octogenarians was graphically summarized using the Kaplan–Meier method. Cox regression analysis was used to identify preoperative risk factors for mortality. Results A greater proportion of octogenarians required intensive care unit admission and discharge to extended-care facilities; however, postoperative length of stay was similar between groups. Among postoperative complications, arrhythmia and renal failure were more likely in the older cohort. Compared to the youngest cohort, in-hospital and 30-day mortality were highest among octogenarians. Overall survival among octogenarians at 1, 3, and 5 years was 87.3%, 61.8%, and 50.5%, respectively. On multivariable Cox regression analysis of baseline demographic variables, presence of stroke (hazard ratio [HR] = 28.5, 95% confidence interval [CI]: 6.1 to 132.7, P < 0.001) and coronary artery disease (HR = 2.5, 95% CI: 1.2 to 5.3, P = 0.02) were significant predictors of overall mortality among octogenarians. Conclusions Thoracoscopic resection can be performed with favorable early postoperative outcomes among octogenarians. Long-term survival, although comparable to their healthy peers, is worse than those of younger cohorts. Further study into preoperative risk stratification and alternative therapies among octogenarians is needed.

Effects of rapid rehabilitation nursing on surgical‐site wound infection and postoperative complications of patients undergoing thoracoscopic lung cancer surgery: A meta‐analysis

“…44 Thoracoscopic lung cancer resection, while minimally invasive, can still lead to complications such as arrhythmias and poor wound healing, adversely affecting postoperative recovery. 45,46 Our results shows that rapid rehabilitation nursing effectively reduces postoperative complications. The rapid rehabilitation nursing protocol involves multidisciplinary integration throughout the perioperative period, optimizing clinical pathways in preoperative preparation, nutritional care, pain management, and catheter care.…”

“…Thoracoscopic lung cancer resection, while minimally invasive, can still lead to complications such as arrhythmias and poor wound healing, adversely affecting postoperative recovery 45,46 . Our results shows that rapid rehabilitation nursing effectively reduces postoperative complications.…”

Robotic Versus Thoracoscopic Sub-lobar Resection for Octogenarians with Clinical Stage IA Non-small Cell Lung Cancer: A Propensity Score-Matched Real-World Study

“…Notably, prior research has directly compared the long-term prognosis between octogenarians with NSCLC who underwent surgical resection and individuals younger than 80 years, consistently showing that the elderly cohort experienced significantly poorer long-term outcomes. 10 , 13 It is believed that octogenarians may derive more significant benefits from limited lung parenchyma resection than younger individuals, and both the JCOG0802 and CALGB140503 trials have shown that sub-lobar resection mitigates respiratory function loss compared with lobectomy. 5 , 6 , 14 , 15 …”

“…Currently, the open thoracotomy approach has been gradually replaced by minimally invasive surgery (MIS) techniques for segmentectomy and wedge resection in treating early-stage NSCLC. 13 , 17 Previous publications have shown that video-assisted thoracoscopic surgery (VATS) sub-lobar resection has many superiorities over traditional thoracotomy, including fewer postoperative complications, faster recoveries, less surgery-related pain, and better qualities of life. 13 , 18 , 19 …”

“… 13 , 17 Previous publications have shown that video-assisted thoracoscopic surgery (VATS) sub-lobar resection has many superiorities over traditional thoracotomy, including fewer postoperative complications, faster recoveries, less surgery-related pain, and better qualities of life. 13 , 18 , 19 …”