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Eur J Cardiothorac Surg 2007;31:142. doi:10.1016/j.ejcts.2006.10.030
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
Department of Cardiothoracic Surgery, Castlehill Hospital, HULL, Yorkshire, UK
Received 23 October 2006; received in revised form 23 October 2006; accepted 25 October 2006.
* Corresponding author. Tel.: +44 1482 875875. (Email: sgunpat{at}hotmail.com).
Key Words: Lung resections • Octogenarians
Riquet et al. [1] have described their experience with pulmonary resections for malignancy in 66 octogenarians. About 35% of the patients in this series had pneumonectomies. They report an overall 5-year survival of 29.1% and an operative mortality of 7.6%. This is in contrast to a 57% 5-year survival in the Matsuoka et al.'s [2] series, which however, had no pneumonectomies.
Twenty percent of the patients had N2 disease. This series confirms the poor survival [no survivors at 5 years and median survival of 11 months] in patients with N2 disease. It would be interesting to know, if this group of patients had any neoadjuvant chemotherapy, and the extent of the resections in these patients.
It is important to carefully assess octogenarians for lung resection and try and define those factors, which would increase operative risk. Unfortunately most series have a small number of octogenarians and it is difficult to identify risk factors in these patients.
Cerfolio and Bryant [3] recently reported the results of lung resection in 51 octogenarians. Patients who received neoadjuvant therapy had three times the risk of developing major morbidity.
Dominguez-Ventura et al. [4] defined the adverse outcome predictors in 379 octogenarians. Predictors of morbidity were male sex, hemoptysis and previous stroke. Operative mortality was 6.3% and significant predictors included congestive heart failure and prior myocardial infarction.
Although elderly patients should not be denied pulmonary resection based on chronologic age, it would appear that neoadjuvant therapy, stage of the disease, extent of the resection and comorbidities (cardiovascular comorbidity in particular) predict increased operative risk in this patient population.
References
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