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Eur J Cardiothorac Surg 1998;13:266-274
© 1998 Elsevier Science NL

Clinical patterns and trends of outcome of elderly patients with bronchogenic carcinoma

Division of Thoracic Surgery, Laval University, Centre de Pneumologie Laval, Sainte Foy, Quebec, Canada.

Received 29 September 1997; received in revised form 15 December 1997; accepted 14 January 1998.

Corresponding author. Present address: Service de Chirurgie Thoracique, Hôpital Sainte-Marguerite, 13274 Marseille, Cedex 9, France. Tel +33 491 744680; fax: +33 491 744590; e-mail: pathomas@ap-hm.fr

Objective: To investigate the clinical characteristics and determinants of operative mortality and long-term survival of elderly patients submitted to pulmonary resection for intended cure of lung cancer. Methods: Retrospective analysis of 500 consecutive pulmonary resections performed in patients aged over 70 years from 1975 to 1996. Predictors of in-hospital mortality were identified by univariate and multivariate analyses. Determinants of long-term outcome were investigated in all survivors, with no patient being lost to follow-up. Results: Mean age was 74±3 years (maximum: 90), and 36 patients were octogenarians. The sex-ratio M:F was 5:3. History of combined cardiovascular or previous neoplastic disease was noted in 193 and 63 patients, respectively. The predominant histology was squamous cell carcinoma (n=243), with a significantly higher incidence in male than in female. Most patients received standard procedures, while 103 patients underwent extended resections for tumors involving the mediastinum (n=44), the chest wall (n=33), the carina (n=2) or had a sleeve resection of the main bronchus (n=24). Procedures were considered to be complete and curative in 459 patients, among whom 294 had a stage I disease. There were 37 (7.4%) in-hospital deaths. Mortality rates following pneumonectomy, bilobectomy, lobectomy and lesser resection were 11:136, 4:34, 22:291, and 0:39, respectively. Age, male gender, hypertension, low FEV₁ and extended procedure were identified as independent predictors of early mortality. Overall survival rates were 33.7 and 12% at 5 and 10 years, respectively. Multivariate analysis demonstrated that the disease stage was the main prognosticator. During the follow-up period, cancer recurrence (n=183; 39.5%) or second primary lung cancer (n=20; 4.3%) occurred in 203 patients, among whom 18 (9%) had a second lung resection. Carcinoma in other systems occurred in 25 patients (5.3%), and major cardiovascular event in 51 (11%). Conclusions: Male and squamous cell carcinoma are characteristic of elderly patients with resected lung cancer. Operative mortality is acceptable for standard resection, and survival figures are concordant with those reported in other series which include younger patients.

Key Words: Lung neoplasms • Aged • Surgery

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