LUNG-CANCER SURGERY IN THE OCTOGENARIAN

From 1981 through 1991, 40 patients 80 years of age or older underwent thoracotomy for curative resection of bronchogenic carcinoma. There were 22 males and 18 females with a mean age of 82.7 years (range 80-88). In three patients, the operation was aborted due to unexpected metastatic disease discovered at the time of thoracotomy. The remaining 37 patients underwent 5 pneumonectomies, 26 lobectomies and 6 segmentectomies or wedge resections. Three of these patients (1 pneumonectomy, 1 lobectomy, and 1 wedge resection) underwent concomitant en bloc chest wall resection. The overall operative mortality rate (in hospital or within 30 days) was 15% (6/40) while there was a 16% mortality rate (6/37) for resected patients. Complications occurred in 18 of 40 patients (45%) but were major in only 12 (30%). Major complications included respiratory insufficiency (6), pneumonia (4), prolonged air leak (2), stroke (1), urinary retention prostatectomy (1), and one unexplained sudden death 2 weeks following discharge. Postoperative stay in the 34 operative survivors averaged 14+/-8.8 days (range 3-47). Univariate analysis revealed that neither gender, extent of lung resection, preoperative NYHA class, history of heart disease nor chronic obstructive pulmonary disease (COPD) were predictive of operative mortality in the 37 patients undergoing lung resection. Age was the only predictor of mortality (survivors 82.2+/-2.2, non-survivors 84.3+/-2.6; P < 0.05). The need for chest wall resection approached but did not quite achieve significance (P < 0.08). Actuarial suvival for all 40 patients at 1 and 3 years is 55% and 40%, respectively. Seventeen of 37 resected patients (46%) are still alive and all but 2 are in NYHA class I or II. These data suggest that 1) lung resection of bronchogenic carcinoma can be undertaken in the octogenarian although increased morbidity and mortality must be expected, 2) advanced age appears to be predictive of mortality, and 3) patients surviving hospitalization can expect reasonable survival with acceptable quality of life.