Early outcome of anatomical lung resection for non-small cell lung cancer in the elderly

Surgery is the mainstay of early-stage lung cancer treatment. However, since life expectancy is constantly increasing, we wanted to investigate whether this principle also applies to elderly (≥70-year-old) patients.

We analyzed a prospectively maintained database on anatomical lung resections at our institute. Patients were divided in two groups: <70 years and ≥70 years (elderly). Outcome indicators were postoperative cardiopulmonary complications rate and 30-day readmission rate. Baseline and surgical characteristics were compared by mean of t-test, Mann-Whitney U test, chi2 and Fisher exact tests. Propensity score matching was performed to account for differences between groups in the outcome's analysis.

We selected 241 patients with lung cancer (2017-2021) who underwent anatomical lung resections. Median age was 70.5 (IQR: 64-76). 133 patients (54%) aged 70 and above. Patients and surgical characteristics (comorbidities, lung function, performance status, type and extension of lung resection and surgical approach) were similar among groups, except for atrial fibrillation (p=0.01) and previous cancer history (p<0.0001) which were more frequent in the elderly group. Non-elderly patients were more frequently active smokers (p<0.0001). Cardiopulmonary complications rate was 23%, 30-day readmission rate was 12.6%. We did not observe any significant difference in all the short-term outcome indicators between the elderly and the younger counterpart. Particularly, complications rate (p=0.91) and 30-day readmission (p=0.84) did not differ between groups.

In our series, short-term outcomes are not compromised in elderly patients. The evolution in surgical strategy and expertise contribute to offer surgical resection with curative intent for lung cancer to a large spectrum of patients.