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Pneumonectomy for bronchogenic carcinoma in the elderly
J Au1, R el-Oakley, E W Cameron
1Department of Thoracic Surgery, City Hospital, Edinburgh, UK.
Summary
Pneumonectomy in elderly patients with lung cancer is feasible, though right-sided tumors and ischemic heart disease increase peri-operative death risk. Survival rates at 1 and 5 years are 40% and 21% respectively.
Area of Science:
- Thoracic Surgery
- Oncology
- Geriatric Medicine
Background:
- Pneumonectomy is a major surgical procedure for lung cancer.
- Elderly patients present unique challenges for thoracic surgery.
- Evaluating outcomes in this demographic is crucial for treatment decisions.
Purpose of the Study:
- To assess morbidity, mortality, and long-term survival after pneumonectomy in elderly patients (≥70 years) with bronchogenic carcinoma.
- To identify pre-operative and post-operative factors influencing outcomes.
Main Methods:
- Retrospective review of 70 consecutive elderly patients undergoing pneumonectomy for lung cancer.
- Analysis of peri-operative mortality, complications, and survival rates.
- Statistical analysis to identify risk factors for mortality.
Main Results:
- Overall peri-operative mortality was 21% (15 deaths).
- Ischemic heart disease and right-sided tumors were significant risk factors for peri-operative death (37% mortality for right pneumonectomy vs. 6% for left).
- Absolute survival rates at 1 and 5 years were 40% and 21% respectively; stage-specific survival varied.
Conclusions:
- Pneumonectomy can be justified in selected elderly patients with lung cancer.
- Right-sided tumors and a history of ischemic heart disease are relative contraindications.
- Careful patient selection and risk assessment are essential for optimizing outcomes.