Pneumonectomy for lung cancer over the age of 75 years: is it worthwhile?☆

Abstract

The objective of the study was to evaluate the outcome in elderly patients (>75 years) submitted to pneumonectomy for lung cancer. Records of 40 elderly patients, who underwent pneumonectomy at our Institution from 1990 to 2008, were retrospectively reviewed. This group was compared with 289 younger patients submitted to pneumonectomy in the same period. In the older group median age was 77 years (range 75-84 years), 16 were right-side procedures. In the younger group median age was 62 years (range 24-74 years), 114 were right-sided procedures. The overall mortality rate was 7.5% and 6.2% in the older and younger groups, respectively (P=0.75); morbidity rate was 35.1% and 17.7% (P=0.01) and five-year survival rate was 32% and 30%, respectively (P=0.85). Right-sided procedures (P=0.0006) were associated with higher risk of mortality and age over 75 years (P=0.01) with increased risk of morbidity; pathological stage was the only predictor of five-year survival. Pneumonectomy appears to be justified even in patients older than 75 years, because short- and long-term outcomes can be acceptable and comparable with those of younger patients. Advanced age alone does not justify denying curative resection of lung cancer, but right-sided procedures require a careful pre- and postoperative approach.

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 ].…”

“…Radical pulmonary resections in that age group of patients are associated with both a higher rate of serious and life-threatening early postoperative complications as well as an uncertain long-term postoperative outcome. In numerous reports, it is emphasised that age alone is not a contraindication for surgical treatment of elderly patients; careful selection of those patients as well as an interdisciplinary assessment prior to surgery should be performed [2 – 5 ]. 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.…”

Comparison of short and long‐term results between sleeve resection and pneumonectomy in lung cancer patients over 70 years old: 10 years experience from a single institution in China

“…reported that right side PN was strongly related to perioperative and six month mortality. Zuin et al . reported that PN appeared to be justified even in patients older than 75 years, because short and long‐term outcomes could be acceptable and comparable with those of younger patients.…”

“…Banganand et al 16 and Rodriquez et al 17 reported that right side PN was strongly related to perioperative and six month mortality. Zuin et al 18 reported that PN appeared to be justified even in patients older than 75 years, because short and long-term outcomes could be acceptable and comparable with those of younger patients. However, a right side procedure was related to a high mortality rate (P < 0.01), therefore, there were few right side PNs in our study.…”

Estudio de la mortalidad como indicador de calidad de las neumonectomías realizadas en pacientes con cáncer de pulmón

“…Esta tendencia a operar a pacientes ancianos se fundamenta en el axioma de que la decisión de una resección pulmonar con intenciones curativas no debe basarse únicamente en la edad cronológica de pacientes. Existen publicaciones de cirugías de resección en pacientes octogenarios, seleccionados adecuadamente en base a pruebas funcionales y con comorbilidades razonables, que concluyen que la morbimortalidad es similar a la de los pacientes más jóvenes[336][337][338][339] . Además es importante recordar que la resección completa del tumor, cuando es posible, ofrece mejores resultados (independientemente de la edad del paciente) en comparación a la radioterapia o quimioterapia en términos de supervivencia340 .El IMC promedio de la muestra fue de 25,6, la diferencia entre hombres y mujeres no fue significativa, se encontró que el 58% de pacientes tenían sobrepeso y obesidad, aunque tan solo el 13% de pacientes presentaron un IMC mayor de 30 y no se tiene constancia de pacientes operados con obesidad mórbida.…”