As the population continues to age, more and more lung cancers are being identified in elderly patients. Age is a known risk factor for postoperative complications after thoracic surgery and has been used to justify performing a non-anatomic wedge resection rather than a lobectomy in elderly patients. The advent of video-assisted thoracic surgery (VATS) has resulted in shorter length of stay and lower complication rates compared to thoracotomy. This study compares short-term outcomes in patients 70 years or older to younger patients.
A retrospective review was performed of all patients undergoing either thoracotomy or VATS for anatomic lobectomy without previous chemotherapy or radiation between April 2006 and April 2009. Patient charts were reviewed to determine risk factors, perioperative complications and length of stay. Student's t-test was used for comparison between groups.
Over the period studied, 86 patients underwent VATS lobectomy. 40 of these were 70 years or older. Baseline pulmonary function testing showed an average FEV1 of 85% predicted (81% younger vs. 90% older, p = NS). Median chest tube duration was 3 days and median length of stay was 4 days in both groups. During the same time period 25 patients underwent thoracotomy for lobectomy with median chest tube duration of 4 days and median length of stay of 6 days. The overall incidence of complications in the VATS patients was 33% and was not different in the two groups (36% younger vs. 30% older, p = NS). The rates of new oxygen requirement, persistent air leak and atrial fibrillation were not different between the groups. There was only one 30-day mortality in the entire cohort (age 66).
In well selected elderly patients VATS lobectomy provides the same benefits over thoracotomy seen in younger patients including decreased length of stay and complication rate.
Advanced age alone should not be considered a contraindication to VATS lobectomy. Elderly patients should be offered lobectomy rather than wedge resection based on the same criteria used in younger patients.
Shari Meyerson, No Financial Disclosure Information; No Product/Research Disclosure Information