Original Article
Surgical Treatment of Lung Cancer in Octogenarians
Abstract
Background: As the population ages, octogenarians are becoming the fastest growing patient demographic for non–small-cell lung cancer. We examined lobectomies and 30-day outcomes in this group compared with younger patients to gain insight into the optimal treatment for this challenging group.Methods: We analyzed data from the American College of Surgeons National Quality Improvement Program for patients with lung cancer undergoing lobectomy during calendar years 2005–2010. We compared clinical risk factors, intraoperative factors, and 30-day operative mortality and major morbidity in octogenarians versus younger patients undergoing either open traditional thoracotomy (OPEN) or video-assisted (VATS) pulmonary lobar resection.
Results: Of 2171 patients who had lobar resections for lung cancer, 245 (11%) were octogenarians. Six hundred eight lobectomies (28.0%) were VATS procedures and 1563 (72.0%) were OPEN procedures. The VATS rate increased as patient age increased (34% VATS for octogenarians vs 27% for patients younger than 80 years; P = 0.01). Thoracic surgeons performed VATS with greater frequency compared with general surgeons, especially in octogenarians (41% VATS for thoracic surgeons vs 29% for general surgeons; P< 0.001). Univariate analysis suggests significantly increased major morbidity (pulmonary, renal, and sepsis), but not operative mortality in octogenarians; however, multivariate predictors of major morbidity include OPEN procedures, preoperative decreased functional status, history of chronic obstructive pulmonary disease, preoperative sepsis, prior radiation, diabetes, and dyspnea on exertion (all P < 0.05), but they do not include advanced age.
Conclusions: Comorbidities predict most increased morbidity in octogenarians, and advanced age per se is not an important multivariate predictor of postoperative morbidity or mortality. The frequency of VATS lobectomy increased with increasing patient age, and VATS predisposes to decreased morbidity in octogenarians.
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Centers for Disease Control and Prevention. Public health and aging: trends in aging—United States and worldwide. MMWR Morb Mortal Wkly Rep. 2013; 52: 101–106.
2. Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol. 2001; 2: 533–543.
3. Schoenstadt A. Lung cancer statistics. http://lung-cancer.emedtv.com/lung-cancer/lung-cancer-statistics.html. Published December 7, 2008. Accessed July 30, 2012.
4. Dominguez-Ventura A, Cassivi SD, Allen MS, et al. Lung cancer in octogenarians: factors affecting long-term survival following resection. Eur J Cardiothorac Surg. 2007; 32: 370–374.
5. Park BJ, Zhang H, Rusch VW, et al. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2007; 133: 775–779.
6. Whitson BA, Andrade RS, Boettcher A, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2007; 6: 1965–1970.
7. Khuri SF, Henderson WG, Daley J, et al. The patient safety in surgery study: background, study design, and patient populations. J Am Coll Surg. 2007; 204: 1089–1102.
8. Campbell DA Jr, Henderson WG, Englesbe MJ, et al. Surgical site infection prevention: the importance of operative duration and blood transfusion—results of the first American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative. J Am Coll Surg. 2008; 207: 810–820.
9. Horn L, Johnson DH. Evarts A. Graham and the first pneumonectomy for lung cancer. J Clin Oncol. 2008; 26: 3268–3275.
10. Karmakar MK, Ho AM. Post-thoracotomy pain syndrome. Thorac Surg Clin. 2004; 14: 345–352.
11. McVay C, Pickens A, Fuller C, et al. VATS anatomic pulmonary resection in octogenarians. Am Surg. 2005; 71: 791–793.
12. Dominguez-Ventura A, Cassivi SD, Allen MS, et al. Lung cancer in octogenarians: factors affecting morbidity and mortality after pulmonary resection. Ann Thorac Surg. 2006; 82: 1175–1179.
13. Fuentes PA. Pneumonectomy: historical perspective and prospective insight. Eur J Cardiothorac Surg. 2003; 23: 439–445.
14. Port JL, Mirza FM, Lee PC, et al. Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery. Ann Thorac Surg. 2011; 92: 1951–1957.
15. Park HA, Detterbeck FC, Boffa DJ, et al. Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes. Ann Thorac Surg. 2012; 93: 372–380.
16. Lewis RJ, Caccavale RJ, Sisler GE. Imaged thoracoscopic surgery: a new thoracic technique for resection of mediastinal cysts. Ann Thorac Surg. 1992; 53: 318–320.
17. Kirby TJ, Mack MJ, Landreneau RJ, et al. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg. 1993; 56: 1249–1252.
18. Berry MF, Onaitis MW, Tong BC, et al. A model for morbidity after lung resection in octogenarians. Eur J Cardiothorac Surg. 2011; 39: 989–994.
19. McKenna RJ Jr. Surgical management of primary lung cancer. Semin Oncol. 2007; 34: 250–255.
20. Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg. 2012; 60: 255–260.
21. Nakajima J, Takamoto S, Kohno T, et al. Costs of video thoracoscopic surgery versus open resection for patients with lung carcinoma. Cancer. 2000; 89: 2497–2501.
