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Lobar and sub-lobar lung resection in octogenarians with early stage non-small cell lung cancer: factors affecting surgical outcomes and long-term results

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Abstract

Objectives

Consensus exists as to the concept that surgical therapy should not be denied based on older age alone. Elderly lung cancer patients with multiple morbidities are increasingly referred for surgical care. The aim of this study was to evaluate the surgical outcomes and the long-term survival in octogenarians with early-stage non-small cell lung cancer.

Methods

Between January 2000 and December 2010, we identified 73 octogenarians who underwent intended curative lung resection for lung cancer in three different thoracic surgery departments. Two surgical groups were defined: patients who underwent lobar resection (group A) and patients who underwent sub-lobar resection (group B).

Results

The in-hospital mortality was 2.7 % without difference between groups. Group B had a lower incidence of post-operative complications, in particular respiratory complications. Chronic renal failure, multi pre-operative comorbidities and type of resection were risk factors for post-operative morbidity. After a mean follow-up time of 63.8 months, the overall survival at 1, 3 and 5 years was 96, 83 and 60 %, respectively. The low-respiratory reserve was associated with worse long-term survival. The intra-operative and post-operative factors able to influence survival were: the cN status, recurrence of disease and local versus systemic recurrence. The type of operation did not influence survival.

Conclusions

In our experience, surgery is a safe and justifiable option for octogenarian patients with early stage NSCLC. Sublobar resection provides an equivalent in-hospital mortality and long-term survival in comparison with open lobectomy but with less postoperative morbidity. Further large-scale randomized studies are necessary to confirm our results.

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Conflict of interest

There has been no duplicate publication or submission elsewhere, all authors have read and approved the manuscript, all the authors will sign an exclusive license to publish and there is no ethical problem or conflict of interest.

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Authors and Affiliations

  1. Thoracic Surgery Unit, S.Orsola Malpighi University Hospital, Via Massarenti 9, Bologna, Italy

    Andrea Dell’Amore, Guido Caroli & Giampiero Dolci

  2. Division of Thoracic Surgery, Morgagni Pierantoni Hospital, Forlì, Italy

    Marco Monteverde, Stefano Sanna & Davide Dell’Amore

  3. Division of Thoracic Surgery, Istituto Nazionale dei Tumori, IRCCS Fondazione Pascale, Naples, Italy

    Nicola Martucci & Gaetano Rocco

Authors
  1. Andrea Dell’Amore
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  2. Marco Monteverde
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  3. Nicola Martucci
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  4. Stefano Sanna
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  5. Guido Caroli
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  6. Giampiero Dolci
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  7. Davide Dell’Amore
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  8. Gaetano Rocco
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Correspondence to Andrea Dell’Amore.

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Dell’Amore, A., Monteverde, M., Martucci, N. et al. Lobar and sub-lobar lung resection in octogenarians with early stage non-small cell lung cancer: factors affecting surgical outcomes and long-term results. Gen Thorac Cardiovasc Surg 63, 222–230 (2015). https://doi.org/10.1007/s11748-014-0493-8

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  • DOI: https://doi.org/10.1007/s11748-014-0493-8

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