[Lung resection in the elderly: some limits]

A progressive and constant increase of mean life duration in the last century has determined the challenge of the treatment of lung cancer even in the elderly with good functional status. The aim of the present study is to evaluate the results obtained in the elderly, over seventy years old, who underwent pulmonary resection at our Division of Thoracic Surgery of Polyclinic of Bari from 1985 to 1995.

938 patients with NSCLC have been operated on, from January 1985 to December 1995. 189 were over seventy and 19 were over eighty years old. We have performed the following surgical procedures: 21 pneumonectomies, 108 lobectomies/bi-lobectomies, 44 wedge resections, 16 staging thoracotomies.

Post-operative complications were as follows: atelectasis 57, air leak 37, empyema 9, broncho-pleural fistula 3, arrhythmia 103, pulmonary edema 8, cardiac ischemia 3, pulmonary embolisms 1, delirium 2, hemothorax 3, exitus 5. There were 3 deaths caused by acute myocardial ischemia, one by pulmonary embolism, one by main right bronchus broncho-pleural fistula. Two and five-year overall survival were 67.1 and 37.8, respectively.

Diagnostic and therapeutical procedures for lung cancer should be different in the elderly. In our experience, main post-operative complications were cardiovascular, consequent to the entity and duration of surgical operation and intra-operative blood leaks. The elderly require a more careful post-operative monitoring to prevent this kind of complications.