Nonsmall cell lung cancer (NSCLC) is best treated by complete surgical resection, most commonly involving lobectomy or pneumonectomy. This study compared the late (> 1 year) effect of thoracotomy with lobectomy or pneumonectomy on patients younger than 70 years old verses those at or older than 70 years of age.
Retrospective review of 159 patients who from July 1996 to December 2001 underwent lobectomy (140) or pneumonectomy (19) for NSCLC at the Minneapolis VA Medical Center. 56 of 66 lobectomy and 5 of 8 pneumonectomy patients were alive > 1 year status-post surgery, and evaluated with pulmonary function testing and functional status assessment based on the Karnovsky score (KS). Results were compared between younger (n=35 lobectomy, 3 pneumonectomy) and older (n=21 lobectomy, 2 pneumonectomy) patients.
Following lobectomy, functional vital capacity (FVC) decreased by 14% and 15%, with forced expiratory volume in one second (FEV1) decreased by 24% and 18% in younger and older patients, respectively. Functional status declined for 11 (31%) of the younger patients with KS drop from 10 (normal activity without limitation) to 7 (unable work, but able to care for self at home). Similarly, 6 (28%) older patients dropped from 9-10 to 7. Following pneumonectomy, results between age groups were nearly identical with an average reduction of 39% in FVC and 45% in FEV1, and average KS decreased from 9 preoperatively to 8 postoperatively.
Elderly patients undergoing lobectomy or pneumonectomy for NSCLC have similar late recovery of pulmonary function and functional status compared to younger patients. Interestingly, the decrease in FEV1 does not directly correlate with a lower KS unless the FEV1 was < 1.0L/sec.
Although, as expected, pneumonectomy has a greater overall impact on a patient than lobectomy, curative resection should not be denied a patient based on age alone.
R.F. Kelly, None.