Surgery for Elderly Lung Cancer

Abstract

Objective: There are still controversies about the surgical benefits for elderly lung cancer. The aims of this study were to assess impacts of aging for non-small cell lung cancer (NSCLC) following pulmonary resection. Methods: A retrospective study was undertaken for patients operated at a curative intent from January 1998 to October 2008. Patients were divided into two groups: Group 1 consisted of patients aged at least 75 years old, and group 2 were patients less than 75 years old. Perioperative characteristics and details, hospital courses, surgery-related morbidities, surgical mortality, and survival were compared between groups. Results: Of 442 eligible patients, 73 patients (16.5%) were in group 1 (mean age 78.3 years) and 369 (83.5%) patients were in group 2 (mean age 62.5 years). The following data were compared with statistical significance: hospital stay (17.8 vs. 8.9 days), mortality rate (8.2 vs. 2.2%), morbidity rate (26.0 vs. 13.3%), and length in intensive care unit (5.7 vs. 3.2 days). The main causes for morbidities in group 1 showed cardiopulmonaryrelated. Tumor stage without considering age had statistically significant influence on survival. Survivals of two groups were comparative. (p = 0.10) Intriguingly, the disease-related survival (28.3 months; p = 0.008) and progression-free survival (25.0 months; p <0.001) in group 1 were significantly better than group 2 (20.2 and 12.2 months). Conclusions: Although operation for NSCLC in the elderly patients causes more complications, especially in the cardiopulmonary system, their outcome showed better than their younger counterparts. Pulmonary resection for elderly patients may get longer disease control. Elderly patients with physical fit for surgery should not be considered as a contraindication to pulmonary resection based on age alone.

Long-term results of surgical treatment of non-small cell lung cancer in patients over 75 years of age

“…This is mainly related to the prolonged life expectancy in the whole population, as well as the possibility of earlier and more appropriate diagnostics and technological development of modern medicine. Patients over the age of 75 years already constitute a significant proportion of the lung cancer population, reaching approximately 30–50% [ 2 , 6 ]. Although surgical treatment of elderly patients poses a significant challenge for thoracic surgeons, as it is associated with a higher risk of postoperative morbidity and mortality compared to younger patients, it is still the best choice for the treatment of lung cancer in elderly patients [ 3 , 6 ].…”

Lobar Lung Resection in Elderly Patients With Non-Small Cell Lung Carcinoma: Impact of Chronic Obstructive Pulmonary Disease on Surgical Outcome

“…[6][7][8][9][10][11] On the other hand the negative impact of COPD after pulmonary resec- The British Thoracic Society, in its guidelines on the selection of patients for lung cancer surgery, recommends that all patients should have equal access to lung cancer services regardless of age. 35 In a large retrospective study with 1073 patients, Takamochi et al reported that the rate of morbidity and mortality after pulmonary resection in elderly patients were similar to those observed in younger patients.…”

“…5 It is generally accepted that elderly patients with non-small cell lung cancer (NSCLC) should not be excluded from curative resection only due to their chronological age as the operative results in this group are similar to that of younger patients. [6][7][8][9][10][11] The negative impact of COPD after pulmonary resections for NSCLC has been discussed in several studies, but the following question still remains to be answered: How fit are elderly patients with COPD for lobar lung resection?…”

Assessment and Optimisation of Lung Cancer Patients for Treatment with Curative Intent

“…It is well established that surgical resection offers patients the best chance of long term cure in early stage lung cancer 1 . Over the past decade there has been a successful drive to increase the number of patients undergoing resection, with the greatest increase in resection rates being noted in older age groups 2,3,4,5 . The advent of Video Assisted Thoracoscopic Surgery (VATS) is further improving access for some who previously would not have been deemed suitable for surgical resection 6,7 .…”

“…As our population ages, the median age of those presenting with lung cancer is increasing and many coming forward for treatment have significant co-morbidities. It is therefore imperative that we develop systems to ensure accurate assessments of physical health including cardiopulmonary reserve, alongside clear diagnostic and staging algorithms which allow as many patients as possible to be treated with curative intent 4 .…”