IMPROVED RESULTS IN THE MANAGEMENT OF SURGICAL CANDIDATES WITH LUNG-CANCER

Background. Perioperative mortality and morbidity after lung resection for carcinoma are generally reported to be 3% to 6% and 15% to 30%, r espectively, and higher in the elderly and those with limited cardiopu lmonary reserve. Methods. To minimize this risk and extend the surgica l option to more high-risk patients, we adopted a protocol in 1991 tha t included preoperative digitalis, subcutaneous heparin and venoocclus ive stockings, aggressive perioperative pulmonary toilet, and video-di rected limited resections for many patients with limited pulmonary res erve. In October 1996, we reviewed our results with 173 consecutive pa tients (median age, 60 years; range, 17 to 89 years) undergoing operat ion for suspected lung carcinoma. Forty-one patients were 70 years old or older, and 70 patients were considered high risk on the basis of a dvanced age (greater than or equal to 70 years), poor cardiac or pulmo nary reserve, or serious medical comorbidity. Procedures included pneu monectomy (n = 31), lobectomy (n = 83), bilobectomy (n = 12), and limi ted resection (n = 45). Two patients had unresectable disease. Results . Hospital mortality was 1.6% (3/173) and morbidity was experienced by 15% (26/173). Among the high-risk subgroup mortality was 4.2% (3/70) and morbidity was 20% (14/70; p < 0.03). For the older patients these values were 4.8% (2/41) and 17.9% (7/41), respectively. Conclusions. M orbidity and mortality from lung resections may be minimized with the perioperative management strategy outlined above. This would allow mor e high-risk patients to benefit from surgical resection, and do so wit h an acceptably low risk. (C) 1997 by The Society of Thoracic Surgeons .