Pulmonary resection for malignancy in the elderly: is age still a risk factor?

Area of Science:

• Thoracic Surgery
• Geriatric Oncology
• Surgical Outcomes Research

Background:

• Increasing prevalence of elderly patients with resectable lung cancer.
• Need to evaluate perioperative risks in this demographic.
• Analysis of long-term trends in surgical outcomes for older adults.

Purpose of the Study:

• To assess modern perioperative morbidity and mortality in elderly patients undergoing lung resection for cancer.
• To analyze trends in surgical outcomes for lung cancer resection in patients aged 70 and older over a 26-year period.

Main Methods:

• Retrospective review of 1506 lung resections for malignancy (1971-1996).
• Focus on 385 elderly patients (≥70 years) compared to 180 younger controls (≤69 years).
• Analysis of 30-day perioperative outcomes including mortality and morbidity, stratified by age and surgical procedure.

Main Results:

• Overall mortality in the elderly group was 4.2% vs. 1.6% in controls; mortality significantly decreased from 11.1% (1971-1982) to 2.6% (1983-1994).
• Major morbidity rates were similar between elderly and younger groups (13.2% vs. 13%).
• Pneumonectomy carried a higher risk of death (12.5%) in the elderly.

Conclusions:

• Age alone is no longer a significant risk factor for mortality in lung cancer resection.
• Elderly patients may still face higher overall morbidity, but major complications are comparable to younger patients.
• Curative lung resection should be considered for functional elderly patients regardless of age, with caution advised for pneumonectomy.