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Eur J Cardiothorac Surg 2005;28:912-913
© 2005 Elsevier Science NL

Letter to the Editor

Pulmonary resections in young octogenarians

Department of Thoracic Surgery, Hairmyres Hospital, Eaglesham Road, Lanarkshire, Scotland G3 8SJ, UK

Received 7 September 2005; accepted 20 September 2005.

^_* Corresponding author. Tel.: +44 141 339 1433. (Email: sgunpat{at}hotmail.com).

Key Words: Lung resections • Survival • Elderly

Matsuoka et al. [1] report their experience with resections for lung cancer in octogenarians. The indications for surgery in this group are determined by the extent of local invasion and distant spread as well as the physiological suitability for surgery. The dilemma is akin to the situation in cardiac surgery in the elderly where we operate for symptomatic improvement or prognostic benefit or both.

The authors are to be commended for the low complication rate, since octogenarians tolerate complications poorly.

Sixty percent of the patients had limited resections. The authors however claim that all patients underwent complete resection of their tumours. Is a limited resection in these patients synonymous with a curative resection? Ginsberg and Rubinstein [2] opined that ‘limited resection, either wedge or segmentectomy, cannot be recommended as a resection of choice for T1N0M0 lung cancer’. While segmentectomy might be a reasonable option in those with early and small tumours, a wedge resection cannot be considered as a curative operation for bronchogenic carcinoma. It would be interesting to compare the results of segmentectomy with wedge resection in this group, although the numbers are low.

It is fortunate that no patient required a pneumonectomy, which has been associated with increased morbidity and mortality rates in the elderly.

Evidently, the extent of the resection was tailored to the physiological status of the patients. Would the authors have performed such a large proportion of limited resections in a younger cohort.

The good results are clearly attributable to their case selection. 35/40 patients had stage 1 disease. All patients had essentially good lung function tests. Even among those with COPD, only a few were on medication. The good results in stages 1 and 2, essentially indicates good survival in those without nodal involvement.

This study raises other issues. Did those with stage 2/3A disease really get a curative resection? Is it worth operating on the octogenarians with malignant N2 lymphadenopathy? Unfortunately, the numbers in these subgroups are inadequate to arrive at conclusions.

Although these patients were chronologically ‘old’, they were biologically and physiologically young. This is a subgroup of elderly patients that self-select for better survival.

It is a general assumption that the elderly who present for thoracic resections have associated co-morbidities and suboptimal pulmonary function. In the absence of these two factors, however, the prognosis improves substantially and we are no longer operating on a cohort of ‘octogenarians’ in the true sense of the term. The report demonstrates that octogenarians can be quite fit and without significant co-morbidities.

It might not be entirely appropriate to generalize that advanced age is not a contraindication to curative resection, since the majority might not have received curative resections. Good results are achievable only in those with early cancer, with minimal comorbidities and with reasonably good pulmonary function.

A couple of decades ago patients above 70 were referred to as being ‘elderly’. A couple of decades later patients in their 80s might actually be in the ‘prime of their lives’!

References

1. Matsuoka H, Okada M, Sakamoto T, Tsubota N. Complications and outcomes after pulmonary resection for cancer in patients 80 to 89 years of age. Eur J Cardiothorac Surg 2005;28(3):380-383.[Abstract/Free Full Text]
2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study. Ann Thorac Surg 1995;60(3):615-622.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ganesh Shanmugam Ali Jilaihawi Dhruva Prakash Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shanmugam, G. Articles by Prakash, D. Search for Related Content PubMed PubMed Citation Articles by Shanmugam, G. Articles by Prakash, D. Related Collections Lung - cancer