SURVIVAL AND PROGNOSIS AFTER PNEUMONECTOMY FOR LUNG-CANCER IN THE ELDERLY

Background. The number of elderly patients with lung cancer is increas ing. This study was undertaken to assess the validity of pneumonectomy for the treatment of lung cancer in this patient group. Methods. Twen ty-seven patients 70 years old or older (elderly group) and 95 patient s younger than 70 years (younger group) who underwent pneumonectomy be tween January 1985 and March 1996 formed the study group. In the elder ly group, 22 patients had squamous cell carcinoma, 2 had adenocarcinom a and 3, small cell carcinoma; 1 patient was in postoperative stage I, 4 patients were in stage II, 14 in stage IIIA, 5 in stage IIIB, and 3 in stage IV of the disease. The only significant differences in patie nt characteristics between the two groups were the percentage of patie nts undergoing right pneumonectomy and the percentage of patients rece iving chemotherapy or radiotherapy within 3 months before or after ope ration or both times. Results. The prognosis for the elderly group was comparable to that of the younger group for all stages of the disease ; the overall 5-year survival rate was 30.5% for the younger group and 11.5% for the elderly group. However, operation-associated mortality was significantly higher in the elderly group (22.2% versus 3.2%; p < 0.005). The prognosis was better for patients with a centrally located tumor than a peripheral tumor in both groups [13.5% versus 2.0% in th e elderly group and 46.7% versus 5.2% (p < 0.01) in the younger group] and significantly better for patients having a left pneumonectomy tha n a right pneumonectomy in the younger group (46.7% versus 5.2%; p < 0 .01) but not in the elderly group (13.7% versus 22.2%). Adjuvant treat ment did not have any beneficial effect on the prognosis in either gro up. Conclusions. Pneumonectomy for lung cancer in elderly patients app ears to be justified because the outcome in our study was comparable w ith that for the younger patients. However, it should be performed onl y in carefully selected patients because of the increased operative ri sk.