Surgery of non-small cell lung cancer in the elderly (original) (raw)
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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.
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.
Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery, 2018
Patients over 75 years of age, who, in addition, often have already exceeded the average life expectancy, in the Polish population on average 77.4 years, are the subject of discussion concerning the most appropriate choice of treatment. To analyse the long-term results in elderly patients over 75 years of age with lung cancer who underwent curative pulmonary resection. 166 patients aged from 75 to 85 (mean: 77.4 ±2.3) operated on for non-small cell lung cancer (NSCLC) were included in this study. There were 128 (77%) men and 38 (23%) women. Lobectomy, including bilobectomy, was performed in 122 (74%) patients, pneumonectomy in 8 (5%) patients, and wedge resections or segmentectomy in the remaining 36 patients. Squamous or adenocarcinoma was diagnosed in 46% and 42% of cases respectively. Clinical stage I A was diagnosed in 36 (22%) patients, I B in 51 (31%), IIA in 30 (18%), IIB in 19 (11%) and IIIA in 30 (18%) of our cases. The early 30-day postoperative mortality was 5% whilst pos...
Interactive CardioVascular and Thoracic Surgery, 2012
OBJECTIVES: Older lung cancer patients with multiple morbidities are increasingly referred to thoracic surgery departments. The aim of this multicenter study was to analyse the prognostic factors for in-hospital morbidity and mortality and to elucidate the predictors of long-term survival and oncological outcomes. METHODS: We identified 319 patients aged ≥75 years who underwent intended curative lung resection for lung cancer in three different thoracic surgery departments between January 2000 and December 2010. RESULTS: Seventy-one patients underwent limited resection, 202 had lobectomy, 16 had bilobectomy and 30 had pneumonectomy. The in-hospital mortality was 6.6%. Chronic renal failure, low respiratory reserve and pneumonectomy were predictors of in-hospital mortality. The mean follow-up time was 3.9 years, ranging from 1 month to 10.4 years. The disease-free survivals at 1, 3 and 5 years were 82, 60 and 47%, respectively. The overall survivals at 1, 3 and 5 years were 86, 59 and 38%, respectively. The long-term overall survival was negatively influenced by pneumonectomy, extended resection, N 1-2 subgroups and pathological TNM stage. CONCLUSIONS: Nowadays, we can consider surgery a safe and justifiable option for elderly patients. Careful preoperative work-up and selection are mandatory to gain satisfactory results. Good long-term results were achieved in elderly patients with early stage who underwent lobar or sublobar lung resection. The role of surgery or other alternative therapies, in patients with advanced stages, extensive nodal involvement and/or requiring extensive surgical resection for curative intent, is still unclear and further studies are certainly needed.
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.
The Annals of Thoracic Surgery, 2003
Background. Operative mortality and morbidity in elderly patients operated on for non-small-cell lung cancer are acceptable. However, risk factors for hospital mortality and the benefits for the patients in the long term are insufficiently defined, and survival compared with the general population is not known. Methods. From January 1989 to October 2001, 126 consecutive patients older than 70 years of age underwent resection for non-small-cell lung cancer. Each patient was scaled according to the Charlson Comorbidity Index. Postoperative events were divided into minor and major complications. Risk factors for complications and longterm survival were assessed by univariate and multivariate logistic regression analysis. Survival was compared with the yearly expected survival rates of the general population. Results. The hospital mortality was 3.2%. Minor complications occurred in 71 (57%) patients, major complications, in 16 (13%) patients. No risk factor was predictive for major complications. However, a Charlson comorbid-ity grade of 3 to 4 was predictive for major complications (odds ratio, 12.6; 95% confidence interval, 1.5 to 108.6). Our study showed a 5-and 10-year survival rate of 37% (95% confidence interval, 23 to 51) and 15% (95% confidence interval, 8 to 22). Smoking (odds ratio, 2.3), chronic obstructive pulmonary disease (odds ratio, 2.1), and pathologic stage IIIA (odds ratio, 2.2) or IIIB (odds ratio, 11.9) were risk factors for long-term survival. The observed survival was lower than the expected survival, but the difference decreased with increasing time after pulmonary resection. Conclusions. Pulmonary resection for non-small-cell lung cancer in patients older than 70 years shows acceptable morbidity and mortality. The Charlson index is a better predictor of complications than individual risk factors. In time survival is no longer correlated with the disease but follows the same pattern as the general population.
Annals of Thoracic and Cardiovascular Surgery, 2019
Purpose: Lung cancer is one of the major sources of mortality in the elderly. This study was undertaken to assess the early and long-term results of surgical resection in patients older than 70 years of age by comparing the results of patients aged 70-79 years (group 1) with patients older than 80 years of age (group 2). Methods: Data on patient age, gender, spirometry values, side, size, histology and stage of the tumor, surgical procedures, postoperative complications, Charlson comorbidity scores (CCS), and survival were collected. Results: After 1-2 propensity score matching group 1 (70-79 years) included 84 and group 2 (age over 80) 42 cases. The multivariate analysis showed that CCS was the only significant factor affecting the development of complications (p = 0.003). The overall median and 5-year survival of all patients were 55 months and 42.5%, respectively. Although the survival of the elderly group 2 was higher than the first group, the difference did not reach significance (50 vs. 49 months, respectively). Conclusion: The outcomes of surgery in terms of morbidity and mortality rates do not differ between the two age groups. The safety of pulmonary resections in the elderly group is comparable to patients under 70 years if the comorbidities are appropriately controlled. In addition, surgery provides satisfactory survival rates in both age groups.
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, ...