PURPOSE: Surgery is the only curative treatment of lung cancer. What is the role and value of surgery if patients are above 70 years of age? What kind of benefit provides surgery and what are the limit for surgical procedures?.
METHODS: Among 4022 lung cancer operations during a 8 years period 205 patients were older 70 years of age (5,1%). 60% of patients had symptoms, while 40% of their lung cancer was discovered being symptoms free. All patients underwent detailed cardiopulmonary test, preoperative rehabilitation, stopped nicotine and if necessary cardiopulmonary working test was was done to evaluate functional tolerance and determine postresectional function. 72 patients had several comorbidity, which was controlled by further medication or some of them were operated on peripheral vascular disease before lung surgery.
RESULTS: 91,2% of patients underwent pulmonary resections, most frequently lobectomy (59,5%), in 23,9% of them had lesser resections but 7,8% of cases pneumonectomy was performed. Histology proved adenocarcinoma in 58,7% and squamous cell carcinoma in 35,4%. Stage distribution were as follows: Stage I:48,8%, Stage II:26,3%, Stage III:18,6% and Stage IV:6,3%. Two patients (1%) died postoperatively and complications occured in 25% of cases. 44 patients received adjuvant oncotherapy (chemo and/or radiotherapy). 96 patients are still alive. The cumulative 5-year survival is 45%. No significant difference was observed in survival between genders, histology, type of resections. Late results deeply influenced by stage of cancer (80% in stage Ia and 18% in stage IIIa at 5-years) and nodal involvement (5 y. survival: 60% with N0 and 8% with N2).
CONCLUSION: If the elderly lung cancer patients undergo meticulous selection and preparation preoperatively, risk of surgery provides acceptable rate. Majority of surgical candidates belongs to lesser stages and to adenocarcinoma group. Parenchyma saving resections was performed more frequently. Significant difference was obtained with stages and nodal involvement in late survival but without significance in gender, histology and type of resections.
CLINICAL IMPLICATIONS: It is emphasized that elderly age is not a contraindication for lung resection alone.
DISCLOSURE: Attila Csekeo, No Financial Disclosure Information; No Product/Research Disclosure Information