Surgery: Indications and Issues (original) (raw)
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Surgery of non-small cell lung cancer in the elderly
Current Opinion in Oncology, 2007
Purpose of review The aim of this review is to analyze recent evidence for optimal treatment of elderly patients with non-small cell lung cancer, focusing on surgery, and possibly to foresee the future strategies to apply in these patients. Recent findings Surgery in elderly patients affected by non-small cell lung cancer is safe and feasible when careful preoperative respiratory and cardiac studies have been carried out and the disease has been properly staged. The surgical treatment is not to be denied in elderly patients due to age per se, but when a major contraindication to surgery has been recognized. 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. Pneumonectomy, extended surgical procedure or preoperative induction chemotherapy are major risk factors for an increased postoperative morbidity and mortality rate. When co-morbidities are present or a patient is 80 years or older, there is evidence that a non-anatomical resection can be performed without affecting long-term results. Summary Due to the aging of the general population, elderly patients will become a large percentage of the cases of non-small cell lung cancer to be treated. Implementing preoperative cardiologic studies and redefining selective respiratory criteria specifically could dramatically improve results.
Journal of Experimental & Clinical Medicine, 2019
Lung age formula proposed by Morris and Temple aimed to contribute toward smoking cessation programme and it was developed by Japanese Respiratory Society. It is considered as an important useful factor for predicting postopera-tive respiratory complications and survival in surgically treated patients with non small cell lung cancer. As the first for Turkish society, we aimed to evalu-ate clinical impact of lung age on postoperative complications in patients with NSCLC aged > 60 y. Survey included anatomically resected 80 NSCLC patients aged > 60 y in OMU Thoracic Surgery Clinic between years 2005 - 2015. Three groups were created using age groups 10, calculated as the difference between lung age and true age. Lung age was calculated according to Japanese Respiratory Society formula. Preoperative, intraopera-tive and postoperative prognostic factors were compared between three groups. Patient numbers in three groups were 18, 17 and 45. In preoperative factors gender, smoking, ...
Complications and outcomes after pulmonary resection for cancer in patients 80 to 89 years of age
European Journal of Cardio-Thoracic Surgery, 2005
Objective: Patients 80 years or older often present with potentially resectable cases of non-small cell lung cancer. Whether such patients should undergo surgical treatment is becoming increasingly important in this rapidly aging society. Methods: From April 1997 through March 2004, 40 consecutive patients with non-small cell lung cancer who were 80-88 years of age underwent complete resection of their tumors, as confirmed pathologically. We reviewed preoperative data including gender, age, history of smoking, pulmonary function, co-morbidity, and induction/adjuvant therapy. Perioperative data consisted of surgical procedure, operative morbidity and mortality, histopathologic type, pathologic stage, and outcome. Results: The procedures comprised 16 lobectomies (40%), 12 segmentectomies (30%), and 12 wedge resections (30%). The histopathologic diagnosis was adenocarcinoma in 22 patients, squamous cell carcinomas in 11, large cell carcinomas in 4, adenosquamous cell carcinomas in 2, and neuro-endocrine cell carcinoma in 1. The disease stage was IA in 21 patients, IB in 14, IIB in 3, and IIIA in 2. There was no perioperative mortality. Eight patients had non-lethal complications (20%), including five with cardiopulmonary complications (parenchymal air leaks persisting for more than 7 days in two patients, interstitial pneumonia in one, bacterial pneumonia in one, and moderate arrhythmias in one) and three with minor complications (depression or confusion). The actuarial survival rates of the 40 patients, including deaths from all causes, were 92.4, 71.6, and 56.9% at 1, 3, and 5 years, respectively. In patients with stage I disease, the respective survival rates were 94.3, 74.3, and 57.3%. Conclusions: Advanced age is not a contraindication to curative resection in patients 80-89 years of age with stage I non-small cell lung cancer.
The elderly patient with surgically resected non-small cell lung cancer — A distinct situation?
Experimental Gerontology, 2012
The worldwide population shift towards older ages will inevitably lead to more elderly patients being diagnosed with cancer. Lung cancer is the number one cause for cancer mortality and surgical resection is the treatment of choice whenever possible. This study investigates whether elderly patients with non-small cell lung cancer (NSCLC) are characterized by distinct clinical and pathologic features and different clinical course after resection. Special emphasis is placed on disease recurrence, which is an important, but rarely described parameter for biological tumor behavior. Sex, stage, histology, differentiation grade, smoking status, performance status, hemoglobin, C-reactive protein, lactate dehydrogenase, Ki-67 index, recurrent disease and overall survival were analyzed in 383 surgically resected NSCLC patients. Calculations were performed comparing patients b 70 to ≥ 70 years. A postoperative follow-up period of 15 years enabled detailed correlations. Rate of disease recurrence and disease-free survival did not differ between any age groups and was not influenced by clinico-pathologic parameters. Elderly patients with a Ki-67 index of > 3% were associated with significantly decreased overall survival time when compared to younger patients (36.3 and 47.3 months respectively, p = 0.029). The biological behavior of NSCLC as reflected by characteristics of disease recurrence is similar for surgically resected patients among different age groups and does not warrant specific recommendations for the elderly surgical patient. The Ki-67 index offers prognostic information for overall survival in the elderly.
Curative resection for lung cancer in octogenarians is justified
Journal of thoracic disease, 2017
Due to an increased life expectancy in a healthy aging population and a progressive incidence of lung cancer, curative pulmonary resections can be performed even in octogenarians. The present study aims to investigate whether surgery is justified in patients reaching the age of 80 years and older who undergo resection for non-small cell lung cancer (NSCLC). In this retrospective multi-centre analysis, the morbidity, mortality and long-term survival of 88 patients (24 females) aged ≥80 who underwent complete resection for lung cancer between 2000 and 2013 were analysed. Only fit patients with few comorbidities, low cardiopulmonary risk, good quality of life and a life expectancy of at least 5 years were included. Curative resections from three thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6 pneumonectomies and 12 segmentectomies or wide wedge resections with additional systematic mediastinal lymphadenectomy in all cases. Final histology revealed squamous cell car...
Current Thoracic Surgery
Background: In this study, the age and cardiac risk factors on mortality, and complications after surgical treatment in lung cancer patients were investigated. Materials and Methods: Between January 2014 and November 2016, 485 patients who underwent lung resections for lung cancer in our clinic, were retrospectively evaluated. Under the age of 70, 412 patients and over 70, 73 patients were grouped as group 1 and 2. Results: Lobectomy was performed in 333 patients (80.8%), pneumonectomy in 43 (10.4%), bilobectomy in 30 (0.7%), segmentectomy in 3 (0.7%) and sleeve lobectomy in 3 (0.7%) in group 1; lobectomy in 65 (89%), pneumonectomy in 4 (5.4%), and sleeve lobectomy in 4 (5.4%) in group 2. Surgical mortality was observed in 5 patients (1.2%) in group 1 and 6 patients (8.2%) in group 2. Complications were observed in 99 patients (24%) in group 1 and 23 patients (17%) in group 2. The mean expected mortality with cardiac risk score in group 1 was 1.24 and 3.5 in group 2. The expected mortality with cardiac risk score and complication rates were tabulated as low, moderate, high and there was no statistically significant difference between score and complication (p = 0.551). Conclusions: According to our study, there were no significant differences in terms of complications, morbidity, mortality and survival rates. There was only a relative increase in surgical mortality over the age of 70, so patients should be carefully treated during and after the surgery. Surgery should be the first treatment to perform in selected patients with lung cancer over the age of 70.