Thoracic Surgery and the Elderly; Is Lobectomy Safe in Octogenarians?

Area of Science:

• Thoracic Surgery
• Geriatric Oncology
• Surgical Outcomes Research

Background:

• Non-small cell lung cancer (NSCLC) is a common cancer in the elderly, with poor survival rates.
• Surgical resection offers significant survival benefits for early-stage lung cancer, regardless of patient age.
• Concerns about surgical risks in older adults often lead to deviations from standard treatment, despite a lack of supporting evidence.

Purpose of the Study:

• To evaluate the influence of advanced age on the safety and outcomes of lung resection surgery.
• To determine if age 80 years or older is associated with increased morbidity or mortality following lung cancer surgery.

Main Methods:

• A retrospective registry study was conducted using Queensland's Cardiac Outcomes Registry (QCOR) Thoracic Database.
• Data from January 1, 2016, to April 20, 2022, were analyzed, including 1,232 patients who underwent lung resection.
• Outcomes such as 30-day mortality, morbidity, re-operation rates, and postoperative stay were compared between age groups, with a focus on octogenarians.

Main Results:

• The study included 1,232 patients with a mean age of 66 years (range 14-91).
• Octogenarians (n=60) did not exhibit increased all-cause morbidity (p=0.09) or 30-day mortality (p=0.06) compared to younger patients.
• Male sex was identified as an independent predictor of morbidity (OR 1.58, p=0.001).

Conclusions:

• Advanced age (≥80 years) did not correlate with increased surgical morbidity or mortality in carefully selected patients undergoing lung resection.
• Age should not be a contraindication for considering surgical resection in elderly patients with early-stage non-small cell lung cancer.
• Appropriate patient selection is key to ensuring favorable outcomes for elderly individuals undergoing lung cancer surgery.