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Original Research: CANCER |

Surgical Management and Outcomes of Elderly Patients With Early Stage Non-small Cell Lung CancerLung Cancer in the Elderly: Postoperative Outcomes: A Nested Case-Control Study

Caroline Rivera, MD; Pierre-Emmanuel Falcoz, PhD; Alain Bernard, PhD; Pascal A. Thomas, PhD; Marcel Dahan, PhD
Author and Funding Information

From the Department of Thoracic Surgery (Dr Rivera), Haut Lévêque Hospital, University of Bordeaux, Bordeaux; Department of Thoracic Surgery (Dr Falcoz), Civil Hospital, University of Strasbourg, Strasbourg; Department of Thoracic Surgery (Dr Bernard), Bocage Hospital, University of Dijon, Dijon; Department of Thoracic Surgery (Dr Thomas), North Hospital, University of Marseille, Marseille; and Department of Thoracic Surgery (Dr Dahan), Larrey Hospital, University of Toulouse, Toulouse, France.

Correspondence to: Caroline Rivera, MD, Thoracic Surgery, Haut Lévêque Hospital CHU Bordeaux, Ave de Magellan 33604 Pessac, Bordeaux, France; e-mail: krorivera@yahoo.fr


Funding/support: The authors have reported to CHEST that no funding was received for this study.

For editorial comment see page 839

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):874-880. doi:10.1378/chest.10-2841
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Background:  The number of oncogeriatric patients with non-small cell lung cancer (NSCLC) is expected to increase in the next decades.

Methods:  We used the French Society of Thoracic and Cardiovascular Surgery database Epithor that includes information on > 140,000 procedures from 98 institutions. We prospectively collected data from January 2004 to December 2008 on 1,969 patients aged ≥ 70 years with NSCLC stage I or II and matched them with 1,969 control subjects aged < 70 years for sex, American Society of Anesthesia score, performance status, and FEV1. Surgical treatment and postoperative outcomes were compared between the two age groups.

Results:  The absence of radical lymphadenectomy was more frequent in the older patients (14%, n = 269) than in the younger patients (9%, n = 170) (P < .0001). There was no significant difference in type of resection between older and younger patients, respectively (pneumonectomy, 8% [n = 164] vs 11% [n = 216]; lobectomy, 79% [n = 1,559] vs 77% [n = 1,521]; bilobectomy, 4% [n = 88] vs 5% [n = 97]; sublobar resection, 7% [n = 143] vs 6% [n = 118]; P = .08). Differences in number (P = .07) and severity (P = .69) of complications were not significant. Postoperative mortality was higher in elderly patients at every end point (30-day mortality, 3.6% [n = 70] vs 2.2% [n = 43] [P = .01]; 60-day mortality, 4.1% [n = 80] vs 2.4% [n = 47] [P = .003]; 90-day mortality, 4.7% [n = 93] vs 2.5% [n = 50] [P = .0002]).

Conclusions:  Elderly patients with NSCLC should not be denied pulmonary resection on the basis of chronologic age alone. Among patients aged ≥ 70 years, 90-day mortality compared acceptably with mortality among younger matched patients. Additionally, the data show that for older patients, a 90-day mortality better represents their real mortality risk than 30- or 60-day figures. Our contemporary, multiinstitutional data importantly reveal that elderly patients, compared with their younger counterparts, do not have increased morbidity, incidence, or severity after pulmonary resection.

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