Lung cancer surgery in the octogenarian

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Abstract
From 1981 through 1991, 40 patients 80 years of age or older underwentthoracotomy for curative resection of bronchogenic carcinoma. There were 22males and 18 females with a mean age of 82.7 years (range 80- 88). In threepatients, the operation was aborted due to unexpected metastatic diseasediscovered at the time of thoracotomy. The remaining 37 patients underwent5 pneumonectomies, 26 lobectomies and 6 segmentectomies or wedgeresections. Three of these patients (1 pneumonectomy, 1 lobectomy, and 1wedge resection) underwent concomitant en bloc chest wall resection. Theoverall operative mortality rate (in hospital or within 30 days) was 15%(6/40) while there was a 16% mortality rate (6/37) for resected patients.Complications occurred in 18 of 40 patients (45%) but were major in only 12(30%). Major complications included respiratory insufficiency (6),pneumonia (4), prolonged air leak (2), stroke (1), urinary retentionprostatectomy (1), and one unexplained sudden death 2 weeks followingdischarge. Postoperative stay in the 34 operative survivors averaged 14 +/-8.8 days (range 3-47). Univariate analysis revealed that neither gender,extent of lung resection, preoperative NYHA class, history of heart diseasenor chronic obstructive pulmonary disease (COPD) were predictive ofoperative mortality in the 37 patients undergoing lung resection. Age wasthe only predictor of mortality (survivors 82.2 +/- 2.2, non-survivors 84.3+/- 2.6; P < 0.05). The need for chest wall resection approached but didnot quite achieve significance (P < 0.08). Actuarial survival for all 40patients at 1 and 3 years is 55% and 40%, respectively.(ABSTRACT TRUNCATEDAT 250 WORDS)

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