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Eur J Cardiothorac Surg 1998;14:40-45
© 1998 Elsevier Science NL
a Division of Thoracic and Cardiovascular Surgery, Hospital of Saint Raphael, 1450 Chapel Street, Orchard Building New Haven, 06511, CT, USA
b Yale New Haven Hospital, New Haven, CT, USA
Received 30 September 1997; received in revised form 10 March 1998; accepted 21 April 1998.
* Corresponding author. Tel.: +1 203 5622257; fax: +1 203 5620728.
Objective: There is an increasing number of elderly patients presenting with potentially-resectable lung malignancy. The objective of this study is to evaluate the modern perioperative morbidity and mortality in patients undergoing oncologic lung resection and to analyse the trend over a 26-year period in our experience. Methods: Between 1971 and 1996, 1506 patients underwent lung resection for malignancy. We reviewed the 30-day perioperative risk in a group of 385 (25.6%) patients aged 70 years and older operated on for intended cure of lung malignancy. Operations included 293 (77%) lobectomies, 24 pneumonectomies (6%), 16 bilobectomies (4%) and 52 wedge or segmental resections (13%). The pathology was bronchogenic carcinoma in 89% and metastasis or other tumours in 11% of patients. We compared the 30-day perioperative risk between the elderly group (age 70 or greater) and a cohort of 180 patients (control) 69 years and younger. Results: The mortality for all resections in elderly group was 4.2% (16/385) and was 1.6% for the control group. Mortality in the octogenarian group was 2.8%. Female gender correlated with a decreased risk of death, with only two of 16 deaths in females (P<0.005). Overall morbidity was higher in the study than in control patients (34% vs. 25%, n.s.), although major morbidity was similar in both groups (13.2% vs. 13%). Abnormal pulmonary-function testing and positive cardiac history did not correlate with increase overall or specific risk. Pneumonectomy carried a higher risk for death, with three of 24 deceased (12.5%; P<0.05). Changes in outcome were analysed over two time periods: the mortality in the early period (1971–1982), 11.1% (8/72), was significantly elevated above the control group, while mortality in the modern period (1983–1994) was not, with a rate of 2.6% (8/313). Conclusions: In our series, mortality associated with operative treatment for lung malignancy in the elderly declined, so age alone no longer appears to be a risk factor. Age remains a risk factor for overall, but not major, morbidity. Pneumonectomy should undertaken cautiously in this age group. Based on this data, functional elderly patients should not be denied curative lung resection based on age alone.
Key Words: Lung resection • Cancer • Elderly
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