Early post-pneumonectomy complications in the elderly

Objective: The surgical treatment of non-small cell lung cancer ((NSCLC) in elderly patients presents a serious challenge to thoracic surgeons. As the re is considerable divergence of opinion about both the mortality and morbi dity rates, it is important to set guidelines for proper patient selection. Methods: Early post-operative complications in 42 patients aged over 70 ye ars who had undergone pneumonectomy because of NSCLC (Group I) were analyze d. The control group (Group II) consisted of 48 patients, also aged over 70 years, but who had undergone lobectomy or wedge resections. In both groups , the pre-operative conditions and 30-day morbidity and mortality were eval uated. Results: Postoperative complications occurred significantly more fre quently in pneumonectomy patients (78.5%) than in Group II (58%). Transient or long-standing arrhythmias were noted in 20 patients (47.6%) from Group I and in 17 (35.4%) from Group II. Pulmonary complications occurred in 17 p atients (40.4%) from Group I and 16(33.3%) from Group Ii. The most importan t factors contributing to postoperative complications in pneumonectomy pati ents were performance status (WHO), chronic obstructive pulmonary disease ( COPD) and elevated level of blood urea nitrogen (BUN). The highest impact o n early mortality in pneumonectomy patients was exerted by COPD, arterial h ypertension, formation of broncho-pleural fistula (BPF), the need for re-th oracotomy and high level of BUN. Conclusions: (1) Pneumonectomy in patients over the age of 70 carries a considerable risk of severe post-operative co mplications and death, when compared to patients with less extensive pulmon ary resections. (2) Elderly patients with impaired performance Status (WHO 2 or more) and co-existing arterial hypertension, COPD and elevated level o f BUN should be considered for pneumonectomy very carefully and cautiously. (C) 2000 Elsevier Science B.V. All rights reserved.