Does age over 80 years have to be a contraindication for lung cancer surgery—a nationwide database study

Pagès, Pierre-Benoît; Mariet, Anne‐Sophie; Pforr, Arnaud; Cottenet, Jonathan; Madelaine, Leslie; Abou-Hanna, Halim; Bernard, Alain; Quantin, Catherine

doi:10.21037/jtd.2018.07.12

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Another French paper which analysed the administrative database [14], showed a crude 30-day mortality rate of 3.85% for octogenarians operated with VATS approach, while with the traditional thoracotomic approach the 30-day mortality rate was 7.9% (p < 0.0001). A more recent paper by the same authors confirmed a higher mortality rate for octogenarians (7.77% vs 3.54%) and also the association between post-operative death and comorbidities and type of surgical resection: pneumonectomy and bilobectomy had higher rates of mortality and significative higher values of OR (3.83 and 2.18, respectively) [15]. Bravo Iniguez [16] compared the post-operative outcomes of lobectomy for NSCLC in elderly patients (>65 years) analysing the ACS-NSQIP database: 30-day mortality was significantly lower for VATS-lobectomy (1.19%) than open lobectomy (3.13%) without a significant increased risk of death for patients aged 75-80 years.…”

Section: Discussionmentioning

confidence: 76%

Post-operative outcomes and quality of life assessment after thoracoscopic lobectomy for Non-small-cell lung cancer in octogenarians: Analysis from a national database

et al. 2021

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Section: Discussionmentioning

confidence: 76%

Post-operative outcomes and quality of life assessment after thoracoscopic lobectomy for Non-small-cell lung cancer in octogenarians: Analysis from a national database

et al. 2021

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“…It provides a huge amount of epidemiological information about hospitalized French patients [26][27][28][29][30][31]. Moreover, data pertaining to pulmonary resection for LC are reliable enough to count such patients, as previously shown in other studies [32][33][34][35][36][37].…”

Section: Limitations and Strengthsmentioning

confidence: 75%

Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study

Bernard

Cottenet

Pagès

et al. 2023

Cancers

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Background. The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). Methods. All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013–2020). We described between-hospital differences in the MIA rate over four periods (2013–2014, 2015–2016, 2017–2018, and 2019–2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. Results. From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019–2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. Conclusions. We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions.

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“…[9][10][11] Moreover, data pertaining to pulmonary resection for lung cancer are reliable enough to count such patients, as previously shown in other studies. [20][21][22][23][24] The authorisations required by the 'Cancer Plan' from 2009 onwards have resulted in fewer hospitals performing lung resections for cancer, going from 253 in 2005 to 146 in 2020. However, this number remains high if we compare it to other comparable countries such as England.…”

Section: Discussionmentioning

confidence: 99%

Mortality and failure-to-rescue major complication trends after lung cancer surgery between 2005 and 2020: a nationwide population-based study

Bernard,

Cottenet,

Pagès

et al. 2023

BMJ Open

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ObjectivesTo estimate the evolution of quality indicators (30-day mortality and failure-to-rescue) inpatients who underwent lung cancer surgery in France over the past 15 years and to study the potential influencing factors.DesignRetrospective cohort study using data from the French hospital database (PMSI).SettingNationwide population-based study.ParticipantsAll patients who underwent pulmonary resection for lung cancer in France (2005–2020) were included (N=1 57 566). Characteristics of patients (age, gender, comorbidities), surgery (surgical approach, type of resection, extent of resection) and hospital (type of hospital, hospital volume for pulmonary resections) were retrieved.Primary and secondary outcome measuresWe studied two outcome indicators: 30-day mortality and failure-to-rescue. We used regression-based techniques (including interrupted time-series) to assess the effects of patient and hospital characteristics on 30-day mortality and failure-to-rescue (number of deaths among patients with at least one major postoperative complication within the 30 days after surgery), adjusting for case mix.ResultsThe 30-day mortality rate increased from 3.8% in 2005 to 4.9% in 2010 and then decreased to 2.9% in 2020. The failure-to-rescue rate decreased from 12.2% in 2005 to 7.1% in 2020. The pneumonectomy rate decreased significantly over time (18.1% in 2005 to 4.8% in 2020) and had the greatest contribution on the reduction of mortality between two periods (2005–2010/2015–2020). The use of video-assisted thoracoscopic surgery or robot-assisted surgery had a great influence on the reduction of mortality (16% of the observed difference in mortality) between the two periods, as did hospital volume.ConclusionsThe change in surgical practices, particularly the reduction in pneumonectomies, could be one of the main reasons for reduction in postoperative mortality and failure-to-rescue in France since 2011. Hospital volume is another important factor in reducing postoperative mortality. Our study should encourage the use of technological or organisational innovation, such as changes in surgical practice and cancer surgery authorisations, to improve quality of care.

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Does age over 80 years have to be a contraindication for lung cancer surgery—a nationwide database study

Abstract: Concerning IHM, age ≥80 had a lower weight than did a previous pulmonary or liver disease and the type of pulmonary resection. Patients over 80s with localized LC and no significant comorbidities should be referred for surgery if lobectomy or sublobar resection could be performed.

Cited by 8 publications

References 24 publications

Post-operative outcomes and quality of life assessment after thoracoscopic lobectomy for Non-small-cell lung cancer in octogenarians: Analysis from a national database

Post-operative outcomes and quality of life assessment after thoracoscopic lobectomy for Non-small-cell lung cancer in octogenarians: Analysis from a national database

Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study

Mortality and failure-to-rescue major complication trends after lung cancer surgery between 2005 and 2020: a nationwide population-based study

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