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Eur J Cardiothorac Surg 2007;31:779-782. doi:10.1016/j.ejcts.2007.01.036
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
a Thoracic Surgery Department, European Institute of Oncology, Milan, Italy
b Epidemiology and Biostatistics Department, European Institute of Oncology, Milan, Italy
c University of Milan School of Medicine, Milan, Italy
Received 13 September 2006; received in revised form 27 December 2006; accepted 15 January 2007.
* Corresponding author. Address: Thoracic Surgery Department, European Institute of Oncology, Via Ripamonti 435 20141 Milan, Italy. Tel.: +39 02 57489665; fax: +39 02 57489698. (Email: francesco.leo{at}ieo.it).
Objective: A higher mortality has been reported after pneumonectomy over the age of 70. The aim of the study was to quantify the additional risk due to age after standard pneumonectomy for lung cancer by a case–control study. Methods: Our clinical database was reviewed to search for patients aged 70 years or more who underwent standard pneumonectomy for lung cancer between 1998 and 2005. A control group of patients younger than 70 (one case/two controls) was matched for sex, cardiovascular disease, American Association of Anaesthetists score, respiratory function, side of pneumonectomy, induction chemotherapy and stage. Overall mortality and morbidity were compared. Long-term survival data were also analysed. Results: During the considered period, 35 patients aged 70 years or more underwent pneumonectomy (30 males, median age 73 years, 15 right-sided procedures). The control group was composed of 70 patients. The two groups were homogeneous in the variables used for matching. Overall mortality and morbidity were 11.4 and 54.2% in the elderly group as compared to 4.3 and 41.6% in controls (p-value not significant). Elderly patients experienced a higher rate of respiratory complications (25.7%) as compared to controls (8.3%, p
= 0.01). At univariate analysis, the only risk factor for death was the occurrence of respiratory complications (OR 6.5, CI 1.8–18.2). At multivariate analysis, age 
70 years (OR 5.36, CI 1.48–19.3) and preoperative chemotherapy (OR 7.65, CI 2.04–28.6) were confirmed as predictors of respiratory complications. Five-year survival was 17.5% in the elderly group and 53.6% in the control group (p
= 0.003). Elderly patients with a better respiratory function (FEV1 > 70%) had a 5-year survival of 45.4%. Conclusions: In the elderly patients, the risk of respiratory complications after pneumonectomy is increased as compared to younger patients with equivalent respiratory function. Age and preoperative chemotherapy are independent risk factors for respiratory complications. A lower mortality and a better long-term survival are obtained in elderly patients with a better respiratory function (FEV1 70%).
Key Words: Pneumonectomy • Elderly • Lung cancer
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