THORACOTOMY IN THE OCTOGENARIAN

Octogenarians are rarely referred for thoracic operations, presumably owing to the perceived morbidity of thoracotomy and the presumed frailty and limited life span of the 80-year-old patient. To determine if these concerns are valid, we reviewed our operative experience in 50 patients 80 years of age or older (mean age, 82.7 years; range, 80 to 91 years; 29 men, 21 women) undergoing thoracotomy between Nov 1, 1980, and May 1, 1990, for cancer (39 patients) and benign disease (11 patients). Procedures included 25 lobectomies (24 cancer, 1 abscess), 4 pneumonectomies (all cancer), 3 esophagectomies (1 perforation, 2 cancer), 3 explorations for cancer, 2 bullectomies, 12 wedge or segmental resections (5 open lung biopsies, 5 cancer, and 1 each for benign nodule and hemoptysis), and 1 thymectomy. Five patients (10%) were operated on emergently for massive hemoptysis (1), Boerhaave's syndrome (1), or rapidly progressive respiratory insufficiency (3) with an operative mortality of 80%. Mortality for elective cases was significantly lower (13%, p < 0.01). Major complications occurred in 19 patients (38%). Univariate analysis performed to identify predictors of operative mortality demonstrated no significant relationship between operative death and patient age, sex, type of operation, diagnosis of malignancy, or the presence of either cardiac disease or chronic obstructive lung disease. Twenty-three patients are alive 2 months to 5 years after thoracotomy. Actuarial survival for the 45 elective patients was 56% and 44% at 1 and 2 years, respectively. These data suggest (1) elective thoracotomy may be performed in the 80-year-old patient with elevated but acceptable morbidity and mortality, (2) urgent operation in a compromised octogenarian yields a prohibitive operative mortality and must be approached with caution, and (3) operative survivors may enjoy extended survival with reasonable function.