Pneumonectomy in Octogenarian Patients (original) (raw)
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Anatolian current medical journal :, 2024
Aims: The primary aim of this study is to evaluate the surgical outcomes of lobectomy and pneumonectomy operations performed due to lung cancer in individuals aged 70 and above, and to analyze the factors influencing these outcomes. Methods: This retrospective study covers lobectomy and pneumonectomy operations performed on 103 lung cancer patients over the age of 70, from January 2018 to December 2021. A dataset was created including patients' demographic information, smoking status, comorbidities, results of pulmonary function tests and echocardiography, preoperative complete blood count, and serum albumin levels, and these data were analyzed. Results: The average age of the patients was 73.3; 83.5% were male, and 16.5% were female. The complication rate was 47.6%, and the 30-day surgical mortality rate was 8.7%. Patients with a high American Society of Anesthesiologists (ASA) score had higher rates of complications and mortality (p=0.015). Low preoperative serum albumin (p=0.017) and hemoglobin (p=0.026) levels were associated with an increased risk of complications. Postoperative outcomes between Video Assisted Thoracoscopic Surgery (VATS) and thoracotomy were found to be similar. Conclusion: The study demonstrates that in elderly lung cancer surgery, comorbidities and preoperative nutritional status are decisive factors affecting surgical outcomes. Preoperative albumin and hemoglobin levels emerge as significant indicators in assessing the risk of postoperative complications. VATS and thoracotomy are surgical techniques with similar safety and efficacy profiles.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: Pulmonary resections after pneumonectomy due to metastases or metachronous non-small cell lung cancer (NSCLC) are rare because of the high potential risk of the second procedure and uncertain long-term results. On the basis of our series (largest in Europe) we tried to assess the long-term survival of patients treated in stage IV NSCLC. Methods: Retrospective analysis was carried out on 18 patients treated at our department by pneumonectomy followed by additional resection in the years 1981-2002 (15 males and 3 females, 44-69 years, mean 57). Eleven pneumonectomies were performed on the right side and seven on the left. Twelve squamous cell carcinomas and six adenocarcinomas were diagnosed. All patients were staged postoperatively as IIB-IIIA (four were N2). Their WHO status ranged between 0 and 1. The second surgical procedure (16 wedge resections, 2 chest wall resections) was performed 4-106 months later (mean 26). The patients staged N2 were radiated postoperatively. Results: There were no early postoperative deaths. The morbidity rate after second surgery was comparable to that observed after ordinary wedge resection. Histology of the lesions removed during the second operation was the same as after pneumonectomy in all patients. The pulmonary function tests (PFT) results worsened significantly but still reached 56-63% of the predicted values. Sixteen resected tumors of the remaining lung were staged T1 (<3 cm), 2 -T3 (<3 cm but infiltration of the parietal pleura on an area of 2-4 cm 2 ). Three patients revealed N2 disease (they were all N0 after pneumonectomy). All patients were considered M1 after second surgery. WHO status after the second procedure remained the same in 8 patients (44%) and worsened in 10 patients (56%). The survival rates were as follows: 11 patients survived 2 years (61%) while 8 patients survived 5 years (44%). The majority of patients died due to lung cancer (70%) but all the rest (30%) due to circulatory or respiratory insufficiency. There was a significant difference ( p < 0.05) in 5-year survival for N0-N1 vs N2 status (63% vs 14% -1 patient) and also regarding the time interval between surgeries: less than 12 months vs more than 12 months (0% vs 63%). Conclusions: Pulmonary resections performed after pneumonectomy due to NSCLC are rare procedures but with an acceptable perioperative risk. The second procedure should be limited to wedge resection. The prognosis is poor for patients with N2 status and for those treated by second surgery earlier than 12 months after the first procedure. #
Srpski arhiv za celokupno lekarstvo, 2007
Introduction: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. Objective. The aim of the study was to analyze the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. Method. The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analyzed depending on preoperative radiographic and bronchoscopic aspect. Statistics: chisquare test, t-test. Results. In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1) between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC) in the lobectomy and pneumonectomy group was 15.83% and 42.73% respecti...
Morbidity and Mortality in Octogenarians With Lung Cancer Undergoing Pneumonectomy
Archivos de bronconeumologia, 2014
Evaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients. Case-controlled retrospective analysis. Study population: Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database. No statistically significant differences were found in BMI (...
Surgery: Indications and Issues
Management of Lung Cancer in Older People, 2013
Surgery in elderly patients affected by NSCLC is safe and feasible when careful preoperative respiratory and cardiac studies have been carried on. The surgical treatment is not to be denied in an elderly patient due to age per se, but when a major contraindication to surgery has been recognized. The long-term survival for elderly patients with early-stage lung cancer treated by anatomical pulmonary resection is comparable to the survival rate of younger patients, as demonstrated by several studies. Nowadays studies in elderly patients have demonstrated that pneumonectomy, extended surgical procedure, and preoperative induction chemotherapy are major risk factors for an increased postoperative morbidity and mortality rate. Anyway, in our opinion, the proper selected elderly patient with NSCLC should be treated in the same way as the younger one, with anatomical pulmonary resection and radical lymphadenectomy. In fact, we believe that implementing preoperative cardiologic studies and rede fi ning selective respiratory criteria speci fi cally for elderly improve surgical results.
Southern Clinics of Istanbul Eurasia, 2018
Lung cancer is still the leading cause of cancer-related death and the incidence continues to increase. The development of one-lung ventilation (OLV) techniques has provided new surgical alternatives. The aim of this study was to investigate the demographic characteristics, anesthetic approaches, and factors that affected the prognosis of patients who underwent OLV in the treatment of lung cancer. Methods: With the approval of the ethics committee, the records of 114 patients who underwent a lobectomy or pneumonectomy with OLV for primary lung cancer were retrospectively reviewed. The age; sex; American Society of Anesthesiologists (ASA) score; comorbid diseases; operation type; complications; the quantity of fluid and blood given; the preoperative, peroperative, and postoperative hemogram and blood gas values; and the rate of postoperative transfer to the intensive care unit (ICU) were investigated. Results: The mean age of the patients was 56.35±12.42 years; 89 (78%) were male and 25 (22%) were female. It was observed that 75 (65.8%) of the patients were smokers. An ASA classification of I-II was seen in 59 patients (51.75%), and an ASA classification of III-IV was noted in 55 patients (48.25%). Hypertension, diabetes mellitus, and chronic obstructive pulmonary disease were the most commonly seen comorbid diseases. The number of patients who received ICU care was 29 (25.43%). Of the admitted patients, 19 (65.5%) were ASA III-IV and 10 (34.5%) were ASA I-II; 19 (65.5%) were intubated and 10 (34.5%) were extubated. In all, 97 (85%) cases were a lobectomy and 17 (15%) cases were pneumonectomy. Twenty (20.6%) of the lobectomy patients and 9 (52.9%) of the pneumonectomy patients were taken to the ICU. It was determined that the age, comorbidities, ASA score, and complications were greater in the ICU patients, as well as the duration of anesthesia and OLV. There were a total of 10 (8%) cases with prolonged air leak, bronchopleural fistula, hemorrhage, or pulmonary edema complications. Conclusion: It was concluded that a careful preoperative evaluation, surgical and anesthetic approach, and postoperative care are important to minimize the risk factors and improve the prognosis of thoracic surgery patients. These include bringing the lung function to the best possible state and assessing patient age, ASA score, comorbid diseases, operation type and anesthetic applications.
Pneumonectomy for lung cancer in the elderly: lessons learned from a multicenter study
Journal of Thoracic Disease
Background: 60% of patients diagnosed with lung cancer are older than 65 years and are at risk for substandard treatment due to a reluctance to recommend surgery. Pneumonectomy remains a high risk procedure especially in elderly patients. Nevertheless, the impact of age and neoadjuvant treatment on outcomes after pneumonectomy is still not well described. Methods: We performed a multicentric retrospective study, analyzing outcomes of patients older than 70 years who underwent pneumonectomy for central primary lung malignancy between January 2009 and June 2019 in 7 thoracic surgery departments: Lucerne and Bern (Switzerland), Hamilton (Canada), Alicante (Spain), Monza (Italy), London (UK), Leuven (Belgium). Survival was estimated with Kaplan-Meier, and differences in survival were determined by log-rank analysis. We investigated pre-and post-operative prognostic factors using Cox proportional hazards regression model; multivariable analysis was performed only with variables, which were statistically significant at the invariable analysis. Results: A total of 136 patients were included in the study. Mean age was 73.8 years (SD 3.6). 24 patients (17.6%) had an induction treatment (chemotherapy alone in 15 patients and chemo-radiation in 9). Mean length of stay (LOS) was 12.6 days (SD 10.39) and 74 patients (54.4%) had experienced a post-operative complication: 29 (21.3%) had a pulmonary complication, 33 (24.3%) had a cardiac complication and in 12 cases (8.8%) patients experienced both cardiac and pulmonary complications. 16 patients were readmitted [median LOS 13.7 days (range, 2-39 days)] and of those 14 (10.3%) required redo surgery. Median overall survival (OS) of the entire cohort was 38 months (95% CI: 29.9-46.1 months); in-hospital mortality was 1.5%, 30-day mortality rate was 3.7%, while 90-day mortality was 8.8% accounting for 5 and 12 patients respectively. Patients receiving neo-adjuvant therapy did not experience a higher incidence of postoperative complications (P=0.633), did not have a longer postoperative course (P=0.588), nor did they have an ^ORCID: Fabrizio Minervini,
Long-term respiratory functional results after pneumonectomy
The aim of this study is to evaluate the long-term respiratory outcome of patients who underwent pneumonectomy for non-small cell lung cancer (NSCLC), analysing functional tests. Materials and methods: Twenty-seven consecutive patients who were candidates for pneumonectomy performed spirometry before and at least 24 months after surgery in the same laboratory. Diffusion of carbon monoxide and the most common dynamic and static lung volumes were evaluated in percentage of predicted and compared. Results: A significant inverse correlation was observed between the preoperative FEV1 (%) and FVC (%) and their postoperative loss, respectively r = À641 ( p < 0.0001) and r = À789 ( p < 0.0001). Also the correlation between the RV/TLC ratio and the FEV1 loss confirmed a better postoperative outcome in patients with major airway obstruction ( p = 0.02). To investigate these data, the series were divided into two groups: group A included BPCO patients with a FEV1 lower than 80%, the others were considered group B. Group B showed a significant major postoperative FEV1 (%) and FVC (%) impairment, 31% versus 12%, p = 0.005, and FVC (%) loss, 37% versus 16% ( p = 0.02), meanwhile group A showed a significant major postoperative RV (%) reduction, 43% versus 17%, p = 0.03. Despite being significantly higher preoperatively in BPCO patients, the RV% becomes similar between the two groups in the postoperative. Conclusions: In our experience patients with major preoperative airway obstruction who underwent pneumonectomy had lower impairment in FEV1% at almost one year after surgery than those with normal respiratory function. The resection of a certain amount of non-functional parenchyma associated with the mediastinal shift, with an improvement of the chest cavity for the remaining lung, could give a reduction volume effect in BPCO/emphysematous patients. #
Is Lung Surgery a Good Option for Octogenarians?
Cirugía Española (English Edition), 2014
Introduction: The number of geriatric patients with lung cancer is expected to increase in the next few years, especially patients over 80, and therefore it is important to know where the therapeutic limits should be drawn. Is surgery a good option in patients over 80? Objective: To show the results of lung resection in patients over 80 years of age to evaluate the safety and short-term results. Materials and methods: Retrospective study of 21 patients who underwent lung resection between October 1999 and October 2011. Results: The mean age of the patients was 82AE2; 13 lobectomies were performed, 5 transegmental resections, 2 segmentectomies, and 1 pneumonectomy. Postoperative complications (28.6%) were: respiratory 66.6%, cardiological 16.7% and digestive 16.7%. Perioperative mortality was 9.5% (2). There was a significant association between mortality and age