Rethinking Age Limits for Robotic Lung Cancer Resection: Contemporary Short-Term Outcomes in Octogenarians

Objective: We sought to assess the outcomes of octogenarians compared to a reference group of younger patients undergoing robotic anatomic lung resection for non-small cell lung cancer (NSCLC) to better understand the postoperative expectations of this elderly patient population. Methods: A prospectively maintained Institutional General Thoracic Surgery Database was queried for patients aged 80 years and above (octogenarians) and 65-75 years (reference group) undergoing robotic lobectomy or segmentectomy for NSCLC between 2015 and 2026. Clinical data and postoperative outcomes were collected and compared using both unadjusted and 1:1 propensity-score matching. Results: In total, 822 patients were identified: 101 in the octogenarian group (mean age 82.4 years [standard deviation 2.2]) and 721 in the reference group (69.7 [3.1], p < 0.001). Postoperative complications that were more frequent in octogenarians included pneumothorax requiring chest tube insertion (5.9% vs. 2.2%, p = 0.043), atrial arrhythmias (18.8% vs. 9.2%, p = 0.005), and urinary tract infections (6.9% vs. 1.7%, p = 0.005). Air leak, atelectasis, pneumonia, respiratory failure, pleural effusion, empyema, and delirium did not differ between the groups. After propensity matching, there were no significant differences in the aforementioned postoperative outcomes. While the unadjusted length of stay was longer in octogenarians (4 days [interquartile range 3-5] vs. 3 [2-5], p = 0.012), this was no longer significant after matching (4 [3-5] vs. 3 [2-5], p = 0.369). There were no statistically significant differences in 30-day readmission rates (p = 0.197) or 30-day mortality (p = 0.781) after propensity-score matching. Conclusions: Among carefully selected octogenarians undergoing robotic anatomic lung resection for NSCLC, no statistically significant differences in short-term postoperative outcomes were detected compared with patients aged 65-75 years after adjustment for baseline differences. These findings support individualized surgical selection beyond chronologic age alone.