Resection rates and postoperative mortality in 7,899 patients with lung cancer

Postoperative death used to be an important complication of resections for lung cancer, especially in elderly patients. To support decision making in a general situation, contemporary results and prognostic factors were evaluated. The computer records of 7899 lung cancer patients, diagnosed from 1984 until 1992 in hospitals connected to the Rotterdam Cancer Registry, were analysed to evaluate resection rates and 30 day postoperative mortality. Resections were carried out in 20% of all patients. In patients 70 yrs of age and older, the resection rate was 14%, and in younger patients 26%. The postoperative mortality was 3.1%; 3.6% for males and 0.4% for females. According to multivariate analysis, age and extent of surgery were the major determinants of operative risk. For patients aged 0-59, 60-69 and > or = 70, postoperative mortality rates were 1.4, 3.5 and 4.0%, respectively. The operative risk was 5.7% after pneumonectomy, 4.4% after bilobectomy, and 1.4% after lesser resections. Pneumonectomies were performed less often in elderly patients: 27% of operations in patients > or = 70 yrs versus 37% of operations in younger patients. Age appears to be related to treatment choice and postoperative mortality in patients with lung cancer. However, even in patients over 70 yrs of age, resections can be performed at acceptable risk, implying that chronological age should not automatically determine treatment decisions.