Pneumonectomy for bronchogenic carcinoma in the elderly

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Abstract
We have reviewed 70 consecutive elderly patients (70 years or older) whounderwent pneumonectomy for bronchogenic carcinoma, in order to evaluatemorbidity, mortality, and long-term survival. The majority of the patientshad stage II (n = 32) or III (n = 25) disease. Fifteen deaths occurred inthe peri-operative period (21%). Pre-operative factors associated withperi-operative death included a history of ischaemic heart disease (P =0.001) and right-sided tumour (peri- operative mortality for rightpneumonectomy = 37%, left pneumonectomy = 6%, P = 0.001). Poor lungfunction (as assessed by pre-operative spirometry), peripheral vasculardisease, cerebrovascular disease, diabetes mellitus, and hypertension werenot significant risk factors for peri-operative death. Post-operatively,the requirement for ventilation, or the development of post-operativemyocardial infarction, adult respiratory distress syndrome and respiratoryfailure were significantly associated with peri-operative death. Over 60%of the patients developed one or more complications. The absolute survivalrates for operative survivors were 51% and 27% at 1 and 5 years,respectively (stage I, 60% and 40%; stage II, 63% and 33%; stage III 33%and 14%). The absolute overall survival rates were 40% and 21% at 1 and 5years, respectively. We conclude that pneumonectomy is justified in elderlypatients but right-sided lesions and ischaemic heart disease should beconsidered as relative contra-indications.

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