Video-assisted thoracic surgery for clinical stage I lung cancer in octogenarians

The purpose of this retrospective study was to investigate the value of video-assisted thoracic surgery (VATS) for clinical stage I lung cancer in octogenarians.

From April 1999 to December 2006, 55 consecutive patients aged older than 80 years with clinical stage I lung cancer underwent VATS pulmonary resection. We reviewed preoperative and perioperative data, morbidity, and mortality occurring within 30 days or before discharge, and long-term survival.

There were 35 men and 20 women with a mean age of 82.7 years (range, 80 to 89 years). The surgical procedures using VATS comprised 37 lobectomies, one bilobectomy, and 17 sublobar resections (7 segmentectomies, 10 wedge resections). Two lobectomies (3.6%) were converted to thoracotomy due to bleeding. The cancer was adenocarcinoma in 38 patients (62.3%), squamous cell carcinoma in 12 (19.7%), bronchioloalveolar carcinoma in 3 (4.9%), large-cell neuroendocrine carcinoma in 3 (4.9%), and others in 4 (6.6%). Postoperative complications occurred in 14 patients (25.6%), including bacterial pneumonia in 4 (7.3%), mild arterial arrhythmia in 3 (5.6%), air leak lasting more than 7 days in 3 (5.6%), pulmonary dysfunction that needed oxygen therapy in 2 (3.6%), aggressive interstitial pneumonia in 1 (1.8%), and six other minor complications. There were two operative deaths (3.6%), one due to bacterial pneumonia on postoperative day 132, and another due to aggressive interstitial pneumonia on postoperative day 105. Median hospital stay was 8.0 days. Median follow-up was 49 months. The actuarial survival rate of the 55 patients was 76.4% at 3 years and 65.9% at 5 years.

With appropriate selection of patients and procedures, VATS can be safely used for lung cancer in octogenarians with good prognostic results.