PULMONARY RESECTION FOR LUNG-CANCER IN OCTOGENARIANS

Background. Octogenarians often present with potentially resectable br onchogenic carcinoma. Older reports noting prohibitive mortality and r ecent surveys documenting continued substantial risk raise concerns ab out the applicability of operation in this age group. Methods. We revi ewed the short-term and long-term results of pulmonary resection for i ntended cure of lung cancer in patients 80 years and older operated on from 1980 through 1995. Our surgical philosophy favored lobectomy ove r lesser resection and generally avoided pneumonectomy in the elderly. Results. Fifty-four octogenarians underwent resection: 43 lobectomies , 2 extended lobectomies, 2 bilobectomies, 3 segmentectomies, 3 wedge excisions, and 1 pneumonectomy. There were two perioperative deaths (3 .7%). The overall nonfatal complication rate was 42%, with a major com plication rate of 11%. Postoperative stay decreased from 8.1 days over all to 6.3 days in the last 3 years. Only 3 patients required temporar y convalescent care after discharge. Actuarial survival at 1, 3, and 5 years was 86%, 62%, and 43%, respectively, for all discharged patient s (n = 52) and 97%, 78%, and 57% for stage I cases (n = 39). Patients with tumors beyond stage I fared poorly. Conclusions. Advanced age per se is neither a contraindication to curative resection nor a routine indication for nonanatomic operations in healthy octogenarians with st age I lung cancer. With proper selection, acute risk should be low. Pn eumonectomy, extended resection, and operation for stage II or III dis ease should be considered only in exceptional cases. (C) by The Societ y of Thoracic Surgeons.