[In Process Citation]

The significance of surgery in elderly patients with lung cancer is debated. The age is a predisposing risk factor for developing cancer thereby the possibilities of surgical procedure is increasing in the elderly patients. To clarify the benefit of surgery in patients with lung cancer aged 70 years and over we reviewed our cohort of 206 patients.

Data of elderly patients out of 4022 lung cancer cases were analysed. 124 patients with lung tumours presented symptomatically and imaging suggested the presence of lung malignancies in 82 patients. 155 tumours were located peripherally, while 51 were central. All patients underwent detailed lung function test and cardiovascular examinations prior to surgery; significant comorbidities were optimised, too.

One patient's data was lost during follow-up. In 122 cases lobectomy was the choice of surgery, 49 patients underwent atypical resection, 16 had pneumonectomies, and 18 explorations were performed. Postoperative mortality rate was 1%. Histology revealed adenocarcinoma in 121 patients, squamous cell carcinoma in 73 patients, small cell carcinoma nine and large cell carcinoma three patients. As far as postoperative staging 100 patients had stage I, 54 had stage II, 38 had stage III (III/a: 34, III/b: 4) and 13 had stage IV disease. 5-year survival was 40%. Survival by histology was 40% for adenocarcinoma and 45% for squamous cell carcinoma at five years. Survival rate for patients with stage I was 58% (st I/a: 75%), with stage II 29%, with stage III 14% (st III/a: 17%), with stage IV no five-year survivor was observed. Lymph node involvement was significantly associated with outcome (5-year survival rate in N0 was 49% in N2: 8%).

Our results confirmed an acceptable perioperative risk and benefit of surgery for elderly patients with lung cancer. The age alone is not a contraindication for lung resection with meticulous patient's selection and active postoperative rehabilitation. More patients had adenocarcinoma than squamous cell carcinoma, similarly to all patients. In the elderly patients limited parenchymal resection is an acceptable alternative. Surgery offers good outcome in early stage disease, but surgery should not be the choice of treatment for advanced cancers (st III/b and st IV especially N2).