Postoperative Outcome After Pulmonary Surgery for Non-Small Cell Lung Cancer in Elderly Patients

Abstract

Background: Lung cancer is the main cause of cancer-related death in the Netherlands. Surgery offers the best potential cure, but lower rates of surgery are recorded for octogenarians because of concerns regarding morbidity and mortality.

Methods: We analyzed the Dutch Lung Surgery Audit database to determine the postoperative outcome of lung cancer resections for patients aged 60 years or more between January 2013 and December 2014. Three groups were compared: patients aged 80 years or more, patients aged 70 to 79 years, and patients aged 60 to 69 years. Multivariable analysis was done of postoperative complications and operative mortality.

Results: In all, 2,133 lung cancer resections were performed, of which 70.5% by video-assisted thoracic surgery. Postoperative complications were observed in 637 patients (29.9%), without any difference among the three age groups (p = 0.278). Factors associated with complications were sex, percentage predicted forced expiratory volume in 1 second, percentage predicted diffusion capacity of lung for carbon monoxide, coronary artery bypass graft, chronic obstructive pulmonary disease, and resection more extensive than limited. The mean operative mortality was 2.1% (44 patients), 6.0% (10 patients) among octogenarians (p < 0.001). Age 80 years or more, percentage predicted forced expiratory volume in 1 second, performance status, and congestive heart failure independently predicted operative mortality.

Conclusions: A higher operative mortality rate was observed among octogenarians, but the incidence of complications was similar in all age groups.