Worsened long-term outcomes and postoperative complications in octogenarians with lung cancer following mediastinal lymph-node dissection

Abstract

We evaluated the effects of mediastinal lymph-node dissection on outcomes in octogenarians with primary lung cancer. Outcomes and postoperative complications were retrospectively investigated in 48 octogenarians with anatomically resected lung cancer, of whom 23 underwent a mediastinal lymph-node dissection (ND2 group) and 25 a limited lymphadenectomy (ND0-1 group). Forty-three patients underwent a lobectomy, two a pneumonectomy, and three a segmentectomy. The five-year survival rate for all was 35%, while that for those in pathological stage I was 43.3% and for those in stage II+III was 21.2%. As for lymph node dissection, the five-year survival rate for the ND0-1 group (54.3%) was superior to that for the ND2 group (21.7%) (P=0.022). For patients in pathological stage I, those rated ND0-1 had a better five-year survival than those rated ND2 (61.9% vs. 28.6%) (P=0.041). In addition, mediastinal lymph-node dissection increased the incidence of postoperative cardiac complications (P=0.004). Our results indicate that major pulmonary resection with mediastinal lymph-node dissection is associated with a higher rate of mortality in octogenarians with lung cancer.

Results of Lung Cancer Surgery for Octogenarians

“…According to some reports, radical mediastinal lymph node dissection in octogenarians resulted in increase of postoperative pulmonary complication, shorter survival, and increase of non-cancer related death. 14,18,19) More short and longterm results of pulmonary resection in octogenarians would need to be estimated.…”

Pulmonary Resection for Lung Cancer in Nonagenarians: A Report of Five Cases

“…Recent studies have shown that pulmonary resection for elderly patients was a safe and feasible treatment for lung cancer, [2][3][4][5][6][7][8][9] especially in Japan ( Table 2). According to these reports, approximately 70% of patients were stage I.…”

“…Several reports have shown that MLND is one of the main risk factors for postoperative complications. 5) On the other hand, we have previously reported the results of surgical treatment in octogenarians with lung cancer. 10) The morbidity was not significantly higher in the patients with lymph node dissection (ND1) than in those without lymph node dissection (ND0), including both hilar and mediastinal dissection.…”

“…Recently, several reports from Japan have shown that surgery for lung cancer in elderly people, including octogenarians, was a safe and feasible treatment. [2][3][4][5][6][7][8][9][10] Moreover, the number of lung cancer cases in nonagenarians is expected to increase rapidly in the near future, and then physicians will have to deal with these patients. However, there have been few reports 11) about the strategy for lung cancer treatment including surgery, chemotherapy, and radiotherapy for nonagenarians.…”

Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer

“…The frequency of post-operative complications in octogenarians was also investigated by Chida and colleagues. 29 Forty-eight patients were divided into two groups: those who received an anatomical lung resection and mediastinal lymphnode dissection (MLND group, n=23), and those who received an anatomical lung resection and regional (hilar) lymph node dissection and/or sampling (MLNS group, n=25). There was no significant difference in the rate of death from cancer extension during the observation period between the groups (MLND 52.3% vs MLNS 53.8%).…”