Surgical treatment of non-small-cell lung cancer in octogenarians

Abstract

Reluctance to recommend lung cancer surgery for octogenarians is partly based on the expectation that the rate of complications and mortality is higher in this group of patients, and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes. Moreover, the belief that radiation therapy and observation yield similar results to surgery in early-stage disease have influenced low resection rates in this population. Nevertheless, advances in surgical techniques, anaesthesia and postoperative care have made surgical lung resection a safer procedure than it was in the past. Judging from the more recent findings, surgery should not be withheld because of postoperative mortality, but suboptimal or palliative treatment may be necessary in patients with poor physical or mental function. To enable informed decision-making, both patients and clinicians need information on the risks of surgical treatment. In this review, available information from the literature was collected in an effort to understand the real benefit of surgical treatment in octogenarians with non-small-cell lung cancer, and to determine what should be done or avoided during the selection course.

Figure 1:

Algorithm for functional evaluation of octogenarian patients being considered for surgical resection of lung cancer—based on recommendations relating to assessment of resectability from evidence-based guidelines for lung cancer proposed by the American College of Chest Physicians. Recommendations were adapted to a specific population and mainly based on physiological and comorbidity conditions. Authors describe how to manage patient selection and how to decide what extension of resection should be performed. The asterix indicates that mediastinoscopy is performed only if lung resection is considered; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity of the lung for carbon monoxide; ppo: predicted postoperative; ASA: American Society of Anaesthesiologists physical status.